小剂量右美托咪定用于PCIA对老年髋部骨折患者术后早期认知功能的影响探析

Effect of Low-Dose Dexmedetomidine on Early Cognitive Function in Elderly Patients with Hip Fracture after Pcia

目的分析小剂量右美托咪定用于PCIA对老年髋部骨折患者术后早期认知功能的影响。方法研究阶段为2015年1月—2017年8月,共纳入研究对象89例,均为行乱步骨折手术治疗的老年患者,根据住院编号后一位奇偶数分为两组,A组采用舒芬太尼,B组采用小剂量右美托咪定联合舒芬太尼,比较两组麻醉效果。结果 A组VAS评分术后6 h(5.22±0.45)分与B组术后VAS评分术后6 h(5.19±0.43)分差异无统计学意义(t=0.968,P>0.05),A组VAS评分术后12、24 h(2.11±0.17)分、(0.98±0.08)分与B组术后VAS评分术后12、24 h(3.14±0.32)分、(1.89±0.11)分差异有统计学意义(t=5.687、6.012,P<0.05)。A组Ramsay镇静评分术后24 h(4.34±0.11)分、术后48 h(1.01±0.02)分与B组Ramsay镇静评分术后24 h(3.02±0.07)分、术后48 h(2.01±0.03)分差异有统计学意义(t=6.495、7.385,P<0.05)。A组与B组患者术前1 dMMSE评分、术后第3天MMSE评分,差异无统计学意义(P>0.05),A组术后第7天的MMSE评分明显高于B组, B组认知障碍发生率4.44%明显低于A组认知障碍发生率21.95%。两组心动过缓和低血压的发生率差异无统计学意义(P>0.05),恶心呕吐的发生率A组明显高于于B组(χ~2=6.065,P<0.05)。结论小剂量右美托咪定复合舒芬太尼用于老年髋部骨折患者对改善术后早期认知功能有积极意义,值得临床推广应用。

Objective To analyze the effect of low-dose dexmedetomidine on early cognitive function in elderly patientswith hip fracture. Methods The study period was from January 2015 to August 2017. A total of 89 subjects were en-rolled in the study. All the elderly patients who underwent surgical treatment of chaotic fractures were divided into twogroups according to the odd number of the hospitalization number. Group A was treated with Sufentanil, group B wastreated with low-dose dexmedetomidine combined with sufentanil to compare the anesthetic effects of the two groups.Results There was no significant difference between the 6th hour （5.22±0.45） points of the VAS score and the 6th hour（5.19±0.43） of the B group after the VAS score. There was no statistical significance （t=0.968, P〈0.05）. There were sta-tistical differences in the VAS scores of group A at 12, 24 h （2.11±0.17）points, （0.98±0.08）points and 12, 24 h （3.14±0.32）points and （1.89±0.11）points after operation. Academic significance （t=5.687, 6.012, P〈0.05）. The score of Ramsaysedation in group A was 24 h （4.34±0.11）points, 48h （1.01±0.02）points, and the Ramsay sedation score of group B was24 h （3.02±0.07）points and 48 h （2.01±0.03）points. Statistically significant （t=6.495, 7.385, P〈0.05）. The preoperative 1dMMSE score and the 3rd MMSE score of group A and group B,the different was statistically significant（P〈0.05）. TheMMSE score of group A was significantly higher than that of group B after operation. The incidence of cognitive impair-ment in group B was 4.44% significantly lower than that in group A. The incidence of cognitive impairment was21.95%. There was no significant difference in the incidence of bradycardia and hypotension between the two groups（P〈0.05）. The incidence of nausea and vomiting was significantly higher in group A than in group B （χ2=6.065, P〈0.05）.Conclusion Low-dose dexmedetomidine combined with sufentanil is a positive predictor of early postoperative cognitivefunction in elderly patients with hip fracture. It is worthy of clinical application.