不同剂量右美托咪定对老年膝关节置换术疗效的影响

The effect of the different dosage of dexmedetomidine on knee arthroplasty in the elderly

目的探讨不同剂量右美托咪定对老年膝关节置换术(KA)疗效的影响。方法按右美托咪定使用剂量的不同将180例单侧KA患者分为低剂量组[0.2μg/(kg·h)]、中剂量组[0.5μg/(kg·h)]、高剂量组[0.8μg/(kg·h)],每组60例。记录不良反应情况。比较3组不同时间点的血流动力学、认知功能情况。结果麻醉后10 min、术中膝关节假体置入时、术毕时的平均动脉压、心率高剂量和中剂量组明显低于低剂量组(P<0.05)。术后12、24、72 h简易精神状况检查量表(MMSE)评分高剂量和中剂量组明显高于低剂量组(P<0.05)。术后72 h认知功能障碍率高剂量和中剂量组明显低于低剂量组(P<0.05)。不良反应发生率中、低剂量组明显低于高剂量组(P<0.05)。结论中剂量[0.5μg/(kg·h)]右美托咪定可有效改善老年KA患者的血流动力学、术后认知功能,且安全性较好。

Objective To investigate the effect of different dosage of dexmedetomidine on the efficacy in elderly knee arthroplasty(KA).Methods According to the dosage of dexmedetomidine,180 patients treated with unilateral KA were divided into the low-dose group[0.2μg/(kg·h)],medium-dose group[0.5μg/(kg·h)],and high-dose group[0.8μg/(kg·h)],with 60 patients in each group.Adverse reactions were recorded and the hemodynamic,and cognitive functions among three groups were compared at different time points.Results The mean arterial pressure,heart rate at 10 min after anesthesia,knee prosthesis placement and operation finish in the high-dose and medium-dose groups were significantly lower than those of the low-dose group(P<0.05).At 12,24,72 h postoperation,the MMSE scores of the high-dose and medium-dose groups were significantly higher than those of the low-dose group(P<0.05).The rate of cognitive dysfunction at 72 h after surgery was significantly lower in the high-dose and medium-dose group than that in the low-dose group(P<0.05).The incidence rate of adverse reactions in the medium-and low-dose group was significantly lower than that in the high-dose group(P<0.05).Conclusions The medium-dose[0.5μg/(kg·h)]dexmedetomidine can effectively improve the hemodynamics and postoperative cognitive function of elderly KA patients,and the safety is better.