不同剂量右美托咪定对老年髋关节骨折患者术后谵妄的 影响

Effects of different doses of dexmedetomidine on postoperative delirium in elderly patients with hip fracture

目的分析不同剂量右美托咪定对老年髋关节骨折患者术后谵妄的影响。方法选取2019年10月—2020年10月期间收治的150例髋关节骨折患者作为研究对象,按照随机数字表法分为A组、B组、C组,每组各50例。A组持续麻醉静脉泵注0.7μg/(kg·h)的右美托咪定,B组持续麻醉静脉泵注0.33μg/(kg·h)的右美托咪定,C组给予等容量的0.9%生理盐水。比较三组围术期指标、应激反应、术后谵妄发生率、认知功能(MMSE评分)、不良反应。结果三组麻醉时间、术后苏醒时间、意识恢复清醒时间、术后谵妄总发生率、不良反应发生率比较,差异无统计学意义(P>0.05);T 2、T 3时点三组应激反应各指标均较T 1时点升高,但在T 4时点回降基本接近T 0时点水平,三组间上述指标水平组间时点、组间时点交互比较,B组升高浮动趋势较小,恢复较快(P<0.05);术后3 h,三组MMSE评分均降低,术后24 h,三组MMSE评分均升高至正常水平,A、B组高于C组,B组评分评分变化最大(P<0.05)。结论持续麻醉静脉泵注0.7μg/(kg·h)与0.33μg/(kg·h)的右美托咪定在围术期恢复上无明显差异,但0.33μg/(kg·h)剂量的右美托咪定应激反应更小,更利于术后认知功能恢复,控制术后谵妄风险,且不良反应较轻。

Objective To analyze the effects of different doses of dexmedetomidine on postoperative delirium in elderly patients with hip fracture.Methods 150 cases of hip fracture patients admitted to our hospital from October 2019 to October 2020 were selected as the research objects,and were divided into groups A,B,and C according to the random number table method,with 50 cases in each group.Group A received continuous anesthesia with intravenous pump of 0.7μg/(kg·h)dexmedetomidine,group B received continuous anesthesia with intravenous pump of 0.33μg/(kg·h)dexmedetomidine,group C was given equal volume of dexmedetomidine 0.9%normal saline.Perioperative indexes,stress response,postoperative delirium incidence,cognitive function(MMSE score)and adverse reactions were compared between the three groups.Results There was no significant difference in the three groups of anesthesia time,postoperative wake-up time,consciousness recovery time,postoperative delirium total incidence,and adverse reaction incidence rates(P>0.05);the three groups of T 2 and T 3 had no significant difference in stress response.The indicators are all higher than the T 1 time point,but the decline at the T 4 time point is basically close to the T 0 time point level.The inter-group and inter-group interaction comparison of the above-mentioned index levels among the three groups shows that the upward and floating trend of group B is smaller.Recovery is quicker(P<0.05);3 hours after operation,the MMSE scores of the three groups all decreased,and 24 hours after operation,the MMSE scores of the three groups all increased to normal levels.Groups A and B were higher than group C,and the scores of group B changed the most(P<0.05).Conclusion Continuous anesthesia intravenous pump injection of 0.7μg/(kg·h)and 0.33μg/(kg·h)of dexmedetomidine showed no significant difference in perioperative recovery,but the right dose of 0.33μg/(kg·h)Medetomidine has a smaller stress response,which is more conducive to the recovery of postoperative cognitive function,controls the risk of postoperative delirium,and has less adverse reactions.