不同剂量右美托咪定对老年患者术后谵妄的影响研究

Influence of Different Doses of Dexmedetomidine on Delirium in Elderly Patients

目的探讨不同剂量右美托咪定对老年患者术后谵妄的影响。方法选取在上海市嘉定区中心医院接受全身麻酔下择期髋部骨折手术的老年患者90例,随机分为A、B、C3组,各30例。A组患者在全身麻醉诱导前静脉泵注0.5μg/kg右美托咪定,B组患者静脉泵注0.3μg/kg,C组患者静脉泵注等量0.9%氯化钠溶液。记录3组患者心动过缓发生率、术中低血压发生率、术中出血量、手术时间、术中异丙酚和芬太尼用量、老年谵妄测验(CAMCR)评分。结果3组患者术中心动过缓发生率、术中低血压发生率、术中出血量、手术时间比较,差异无统计学意义(P>0.05)。3组患者术中异丙酚和芬太尼用量比较,差异有统计学意义(P<0.05)。3组患者谵妄发生率比较,差异有统计学意义(P<0.05)。手术前后3组患者CAM-CR评分比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);右美托咪定用量和时间在CAM-CR评分上存在交互作用(P<0.05)。结论0.5μg/kg的右美托咪定能減少老年患者术后谵妄发生率,0.3μg/kg的右美托咪定能降低CAM-CR评分。

Objective To explore the influence of different doses of dexmedetomidine on delirium in elderly patients. Methods A total of 90 patients undergoing elective hip - fracture operation under general anesthesia were selected in Central Hospital of Shanghai Jiading District, and they were randomly divided into A, B, C 3 group, each of 30 cases. Before anesthesia patients in A group induction of intravenous infusion of dexmedetomidine 0. 5 g/kg, patients in B group induction of intravenous infusion of dexmedetomidine 0. 5 g/kg, patients in C group induction of intravenous infusion of 0. 9 % NaCl. The incidence of cardiac rate, incidence of intraoperative hypotension, intraoperative blood loss, operation time, the amount of propofol and fentanyl, CAM - CR score were compared among the three groups. Results No statistically significant differences of incidence of cardiac rate,incidence of intraoperative hypotension, intraoperative blood loss, operation time was found among the three groups （P 〉 0. 05 ）. There was statistically significant differences of the amount of propofol and fentanyl among the three groups （P 〈 0. 05 ）. No statistically significant differences of incidence of delirium was found among the three groups （P 〉 0. 05）. The CAM - CR score of the three groups were statistically significantly different （ P 〈 0. 05 ） ; the difference was statistically significant in different time points （P〈0.05） ; there was interaction between groups and time points （P 〈 0. 05 ） . Conclusion 0. 5 μ g/kg dexmedetomidine can decrease the incidence of postoperative delirium in the elderly patients undergoing hip - fracture operation, 0. 3 μg/kg dexmedetomidine can lower the CAM - CR score.