右美托咪定对外科重症监护病房老年头颈部肿瘤患者术后谵妄的影响

Effect of Dexmedetomidine on Postoperative Delirium in the Elderly with Head and Neck Tumor in SICU

目的观察右美托咪定对外科重症监护病房(SICU)老年头颈部肿瘤患者术后谵妄发生的影响。方法选取75例行择期头颈部肿瘤手术患者,年龄≥65岁,术后入SICU。随机分为右美托咪定镇静组(观察组)和常规治疗组(对照组),观察组以0.2μg·kg-1·h-1的速度持续静脉输注右美托咪定12 h。对照组以0.02 mg·kg-1·h-1速度持续静脉输注咪唑安定12 h。观察入SICU即刻(T1)、入SICU后12 h(T2)、24 h(T3)、48 h(T4)和72 h(T5)各时间点患者的心率、平均动脉压、谵妄发生率及患者SICU住院天数。结果 T2时间点,2组心率分别为(67.58±1.53)、(79.37±2.06)次/min,差异具有统计学意义(P<0.05);2组平均动脉压差异无统计学意义(P>0.05)。其余时间点,2组心率血压均无统计学差异(P>0.05)。T2、T3时间点,观察组术后谵妄发生率分别为3例(9.09%)、4例(12.12%),对照组发生率分别为10例(33.33%)、12例(40.00%),2组比较差异具有统计学意义(P<0.05);T4、T5时间点,观察组术后谵妄发生率分别为9例(27.27%)、4例(12.12%),对照组发生率分别为11例(36.67%)、5例(16.67%),2组术后谵妄发生率差异无统计学意义(P>0.05)。2组患者SICU住院天数比较差异无统计学意义(P>0.05)。结论 SICU老年头颈部肿瘤患者,以0.2μg·kg-1·h-1的速度持续静脉输注右美托咪定能在一定程度上降低术后谵妄的发生率,对血流动力学不产生明显影响。

Objective To observe the effect of dexmedetomidine on postoperative delirium in the elderly with head and neck tumor in SICU. Methods A total of 75 elderly with head and neck tumor undergoing selective surgery,aged≥65 years,were admitted to SICU after operation and randomly divided into 2 groups: observation group(dexmedetomidine sedation) and control group(routine treatment);the elderly in observation group received continuous intravenous infusion of dexmedetomidine at the speed of 0.2 μg·kg-1·h-1 for 12 hours while the elderly in control group received intravenous infusion of midazolam at the speed of 0.02 mg·kg-1·h-1 for 12 hours;heart rate, mean arterial pressure,incidence of delirium and days in SICU were observed at the time point of getting in SICU(T1),12 h(T2),24 h(T3),48 h(T4),72 h(T5) after entering SICU. Results At T2,the heart rate of the elderly in observation group was of statistical difference from that of the elderly in control group [(67.58±1.53) bpm vs(79.37±2.06) bpm,P<0.05]while no significant difference was found in mean arterial pressure between the two groups(P >0.05);at other time points,the heart rate and blood pressure of the elderly in the 2 groups were of no statistical difference(P >0.05);at T2 and T3,postoperative delirium occurred in 3(9.09%) and 4(12.12%) elderly in observation group while in 10(33.33%) and 12(40.00%) elderly in control group,the difference between the 2 groups was of statistical significance(P<0.05);at T4 and T5,postoperative delirium occurred in 9(27.27%) and 4(12.12%) elderly in observation group while in 11(36.67%) and 5(16.67%) elderly in control group,the difference between the 2 groups was of no statistical significance(P >0.05);there existed no significant difference in days in SICU between the 2 groups(P >0.05).Conclusion Continuous intravenous infusion of dexmedetomidine at the speed of 0.2 μg·kg-1·h-1 can reduce the incidence of postoperative delirium in the elderly with head and neck tumor in SICU and leads to no obvious impact on hemodynamics.