术中及术后使用右美托咪定对老年髋关节术后认知功能障碍的影响

Effect of Intraoperative and Postoperative Use of Dexmedetomidine on the Postoperative Cognitive Dysfunction of Senile Hip Joint

目的观察术中及术后使用右美托咪定对老年髋关节术后认知功能障碍的影响。方法选择该院2015年1月—2016年12月ASAⅡ~Ⅲ级、年龄大于65岁、行髋关节手术100例,随机分为两组,盐酸右美托咪啶组(D组)和对照组(C组),每组50例。两组患者在年龄、性别、手术时间、术中出入量(出血量、液体总入量及总尿量)差异无统计学意义(P>0.05)。两组麻醉诱导及维持方法相同。麻醉诱导前10 min D组静脉给予1μg/kg盐酸右美托咪啶泵注,继之以0.6μg/(kg·h)直至手术结束前10 min停止泵注。D组舒芬太尼2μg/kg+右美托咪定3μg/kg+盐酸格拉司琼氯化钠注射稀释至100 m L。分别于手术前1 d及手术后第4天及第7天由不知分组情况的麻醉医师对病人进行MMSE评分。并记录麻醉时间、手术时间、术中出血量、液体总入量及总尿量。结果两组术前MMSE评分比较差异无统计学意义[C组为(25.4±2.3)分,D组(24.8±2.1)分;(t=1.362,P=0.176>0.05)]。C组术后第1天、第4天及第7天均较术前明显降低[(C组分别为(18.7±1.8)分、(19.1±1.6)分、(20.2±2.2)分;D组分别为(20.3±2.4)分、(22.4±1.9)分、(23.7±1.94)分;(t=16.221、15.90,11.55,P=0.000<0.05)];D组术后第1天及第4天及第7天较术前明显降低(t=9.98、5.99,11.55,P=0.000,0.000及0.008)。两组在术后第1天(t=3.771,P=0.000)、术后第4天(t=9.394,P=0.000)、术后第7天(t=8.437,P=0.000)的MMSE评分差异有统计学意义。结论围术期使用右美托咪定可改善患者的预后。

Objective To observe the effect of intraoperative and postoperative use of dexmedetomidine on the postoperative cognitive dysfunction of senile hip joint.Methods 100 cases aged more than 65 years old with hip joint surgery whose ASA wasⅡ~Ⅲin our hospital from January 2015 to December 2016 were randomly divided into the dexmedetomidine hydrochloride group(D group)and control group(C group)with 50 cases in each,and there were no obvious differences in the age,gender,operation time,intraoperative intake and output(intraoperative bleeding loss,total fluid intake and total volume of urine),and the anesthesia induction and maintain method of the two groups were the same(P>0.05),and the group D adopted the intravenous pumping of 1μg/kg dexmedetomidine hydrochloride at 10min before anesthesia induction and then 0.6μg/(kg·h)until 10 min at the end of operation,the group D adopted the 2μg/kg sulfentanyl,3μg/kg dexmedetomidine and injection of granisetron hydrochloride sodium chloride diluted to 100 mL,and he patients were given the MMSE score by the anesthetists at 1d before operation,at 4 d and 7 d after operation,and the anesthesia time,operation time,intraoperative bleeding amount,total fluid input and total volume of urine were recorded.Results The difference in the preoperative MMSE score between the two groups was not statistically significant[the group C(25.4±2.3)points,the group D(24.8±2.1)points,(t=1.362,P=0.176>0.05)],and these indexes obviously decreased at 1d,4d and 7d after operation compared with those before operation[the group C(18.7±1.8)points,(19.1±1.6)points,(20.2±2.2)points;the group D(20.3±2.4)points,(22.4±1.9)points,(23.7±1.94)points;(t=16.221,15.90,11.55,P=0.000,0.000,0.000<0.05)],and there were obvious differences in the MMSE scores at 1 d,4 d and 7 d after operation(t=3.771,P=0.000),(t=9.394,P=0.000)and(t=8.437,P=0.000).Conclusion The use of dexmedetomidine during the preoperative period can improve the prognosis of patients and reduce the incidence rate of postoperative cognitive dysfunction.