右美托咪定预防老年口腔肿瘤患者术后谵妄的疗效分析

Preventive effect of dexmedetomidine on postoperative delirium in elderly patients with oral cancer

目的:评价右美托咪定预防老年口腔肿瘤患者术后谵妄的临床效果。方法 :选取156例在全麻下行根治术的老年口腔肿瘤患者,随机分为观察组(78例)和对照组(78例)。所有患者手术结束后经过2 h的麻醉复苏室过渡后转入SICU。随后,观察组给予静脉泵注生理盐水稀释的右美托咪定注射液0.2μg/(kg·h)维持12 h,对照组给予等体积的生理盐水静脉泵注。所有患者术后都给予同样剂量的曲马多+托烷司琼镇痛。在术后3 d内,每天8:00和20:00按照CAM-ICU(confusion assessment method for the intensive care unit)方法评估谵妄发生情况,并进行VAS疼痛评分和Richmond镇静躁动评分(richmond agitation sedation scale,RASS)。采用SPSS16.0软件包对数据进行统计学分析。结果:观察组患者术后疼痛评分、术后心动过缓和低血压发生率与对照组比较无显著差异,2组均无呼吸抑制发生。观察组术后第1天及第2天的镇静躁动评分优于对照组。观察组术后谵妄、恶心、呕吐发生率低于对照组。结论:右美托咪定术后0.2μg/kg.h维持12 h,可改善老年口腔肿瘤患者的术后镇静状况,减少术后谵妄发生,且不会引起心动过缓及低血压。

PURPOSE： To observe and analyze the preventive effect of dexmedetomidine on postoperative delirium in elderly patients with oral cancer. METHODS： One hundred and fifty-six elderly patients with oral cancer who received radical surgery under general anesthesia were studied. They were randomly divided into 2 groups： experimental group （n= 78） and control group （n=78）. All patients stayed in PACU for 2 hours after surgery, and then were transferred to SICU when they had waken up. Subsequently, patients in experimental group were assigned to take intravenous dexmedetomidine at a dose of 0.2μg/kg.h for 12 hours while patients in control group were assigned to take intravenous normal saline for 12 hours. All patients were given compound analgesia consisted of tramadol and tropisetron in the same dose. During the first three postoperative days, patients were evaluated with the Confusion Assessment Method for the Intensive Care Unit （CAM-ICU）, Visual Analogue Scale and Richmond Agitation Sedation Scale twice a day（8：00 am and 8：00 pm）. Statistical analysis was performed using SPSS16.0 software package. RESULTS： There was no significant difference on postoperative VAS, the incidence of postoperative bradycardia and hypotension between 2 groups. In addition, no postoperative respiratory depression was found in 2 groups. Richmond Agitation Sedation Scale on the first and second day after surgery in the experimental group was better than in the control group. The incidence of postoperative delirium, nausea and vomiting in the experimental group was lower than in the control group. CONCLUSIONS： Intravenous dexmedetomidine at a dose of 0.21μg/kg.h for 12 hours after operation in elderly patients with oral cancer can ameliorate postoperative sedation status, reduce the incidence of postoperative delirium, and will not cause postoperative bradycardia, hypotension and other complications.