右美托咪啶对高龄髋关节置换术患者术后谵妄的影响

Effect of dexmedetomidine on postoperative delirium in elderly patients undergoing hip joint replacement

目的探讨右美托咪啶术中持续小剂量输注对高龄髋关节置换术患者术后谵妄的影响。方法将择期行全髋关节置换术患者120例随机分为D、C 2组各60例,患者均侧卧位下行腰椎-硬膜外联合阻滞(CSEA)术,于L3—4蛛网膜下腔穿刺成功后,注入混合液(0.75%布比卡因2 mL+10%葡萄糖溶液1 mL)1.8 mL,并置入硬膜外导管。调整感觉阻滞平面达T8,期间静脉补充晶体胶体液维持血流动力学稳定,必要时给予苯肾上腺素或阿托品。血流动力学稳定,麻醉平面达T8并固定后开始手术。D组在切皮前静脉开始输注右美托咪啶0.2μg/(kg·h)至术毕,C组输注等量等速的生理盐水。术中输注液体,必要时应用血管活性药物维持血压波动在基础值的±20%。手术结束时连接硬膜外术后镇痛泵(PCEA)。记录各组高血压、低血压及心动过缓发生的例数以及苯肾上腺素、阿托品、硝酸甘油的用量。根据ICU谵妄评估法评估并计算术日(D0)、术后第1天(D1)、术后第2天(D2)、术后第3天(D3)及术后3 d内(D4)谵妄的发生率。结果与C组比较,D组中患者心动过缓发生率显著升高(P<0.05),需要阿托品治疗的例数显著增多(P<0.05),2组间高血压和低血压的发生率及苯肾上腺素、硝酸甘油使用剂量比较差异均无统计学意义(P均>0.05)。与C组比较,D组患者D0、D1及D4谵妄发生率显著降低(P均<0.05),2组患者D1、D2和D3谵妄发生率均显著低于D0(P均<0.05)。结论右美托咪啶持续输注可降低高龄髋关节置换术患者术后谵妄的发生。

Objective It is to approach the influence of dexmedetomidine on postoperative delirium in the elderly patients undergoing hip joint.replacement, Methods One hundred and twenty patients scheduled for elective total hip joint replacement were randomly divided into dexmedetomidine group （group D） and control group （group C） , 60 cases in each group. Spinal anesthesia was performed at L3 -4 interspace and 1.8 mL mixture （0.75% bupivacaine 2 mL combined with 10% glucose solution 1 mL） was injected into the subarachnoid space over 10 s in both groups. Dexmedetomidine was intravenously infused at 0.2 μg/（kg · h） from the beginning of incision to the end of operation in group D, while the equal volume of normal saline was infused in group C. The cases of hypertension, hyp0tension and bradycardia, and the does of phenylephrine, atropine and nitroglycerin were observed and recorded. The incidence of delirium in surgery day （D0） , 1st day （Dl ） , 2nd day （D2 ） , 3rd day （ D3 ） and within 3 days after operation （ D4 ） were evaluated. ResultsCompared with group C, the incidence of bradycardia in group D was markedly increased （ P 〈 0.05 ） , and more cases need atropine （P 〈 0.05 ） , but there was no significant difference in incidence of hypertension, hypotension and dosage such as phenylephrine and nitroglycerin between both groups （all P 〉 0.05）. Compared with group C, the incidences of delirium in D0 , D1 and D4 were significantly decreased in group D （all P 〈 01 05）. The incidences of delirium in D1, D2 and D3 were markedly decreased in Do （all P 〈 0.05 ）. Conclusion Dexmedetomidine can reduce the occurrence of postoperative delirium in in eldly patients undergoing hip joint replacement.