右美托咪定辅助麻醉对老年重症患者术后谵妄的影响

Effect of dexmedetomidine on postoperative delirium in elderly patients with severe diseases

目的观察右美托咪定辅助麻醉对老年重症患者术后谵妄发生情况的影响。方法选择2014年110月于我院择期行腹部手术治疗的67例老年重症患者为研究对象，随机分为观察组35例和对照组32例，观察组持续静脉滴注右美托咪定，负荷剂量1μg／kg，维持剂量0．2μg·kg^-1·h^-1；对照组静脉滴注同体积的生理盐水替代。观察两组患者拔管时间、苏醒时间和谵妄发生情况。结果观察组苏醒时间和拔管时间分别为（18．4±6．9）min和（25．8±7．3）min，均早于对照组（24．6±7．4）min和（31．2±9．1）min，差异有统计学意义（t=4．626、3．494，均P〈0．001）；观察组患者谵妄发生率8．6％（3／35），明显低于对照组28．1％（9／32）（X^2=7．063，P=0．008）。结论右美托咪定辅助麻醉可明显缩短老年重症患者苏醒时间和拔管时间，还可降低患者术后谵妄的发生率。

Objective To observe the effect of dexmedetomidine anesthesia on postoperative delirium in elderly patients with severe diseases. Methods 67 elderly patients undergoing abdominal operation in our hospital from Jan. 2014 to Oct. 2014 were chosen as the research subjects, and randomly divided into the observation group （n = 35） and the control group （n = 32）. In the observation group, 35 cases were treated with dexmedetomidine in loading dose of 1 μg/kg and maintenance dose of 0.2 μg/kg. In the control group, 32 cases were treated with the equal volume of saline instead of dexmedetomidine. The extubation time, recovery time and incidence of delirium were observed. Results The recovery time and extubation time were shorter in observation group than in control group [（18. 4±6. 9） min w （24.6±7.4） min, （25.8 ±7.3） vs （31.2±9.1） min, t= 4. 626, 3. 494, both P〈0. 001]. The incidence rate of postoperative delirium was lower in observation group much than in the controlgroup （8.6%vs 28.1%, k7=7.063, P=0.008）. Conclusions Dexmedetomidine anesthesia can significantly shorten the recovery time and extubation time, and reduce the incidence rate of postoperative delirium in elderly patients with severe diseases.