盐酸右美托咪定在老年股骨颈骨折手术中的应用和术后认知功能的影响

Application and Influence on Cognitive Function after Surgery of Dexmedetomidine Hydrochloride in Elderly Patients with Femoral Neck Fracture

目的:探讨盐酸右美托咪定在老年股骨颈骨折手术中的应用和术后认知功能的影响。方法:以2018年1月-2019年1月的60例股骨颈骨折拟行手术治疗的老年患者为研究对象,60例患者随机分为2组,观察组诱导前泵注右美托咪啶1μg/kg,诱导后泵注0.5μg/kg/h右美托咪啶,对照组泵注等剂量生理盐水,2组都在手术停止前10分钟完成输注。2组给予同样的麻醉方法,诱导后均泵注3μg/kg/h瑞芬太尼.3-5mg/kg/h丙泊酚及间断静脉注射顺式阿曲库胺维持麻醉深度。比较2组患者术后认知功能障碍(P0CD)发生率及评估简易精神状态量表(MMSE)评分。结果:2组患者在年龄、性别、手术时间、术中出血量等术中情况比较差异无统计学意义(P>0.05)。观察组患者在术后1、4、7天的POCD发生率低于对照组(P<0.05);观察组患者术后1.47天MMSE评分高于对照组(P<0.05)。结论:对老年股骨颈骨折手术患者采取盐酸右美托咪定麻醉方式能降低术后认知功能的改变,有助于减轻P0CD的发生。

Objective:To explore application and infuence on cognitive function after surgery of dexmedetomidine hydrochloride in elderly patients with femoral neck fracture.Methods:Sixty cases of elderly patients with femoral neck fracture who were admitted to hos-pital between January 2018 and January 2019 were randomly divided into two groups:group D(n=30)and group C(n=30).Before in-duction,the group D accepted the intravenous infusion of dexmedetomidine hydrochoride(1μg/kg)in 10min and then 0.5μg/kg/h until 10 min before the end of operation.whereas the group C accepted saline infusion.Both groups were given same anesthesia method and re-ceived intraoperative intravenous infusion of remifentanil(3μg/kg/h)and propofol(3-5mg/kg/h)and intermittent bolus injection of ci-satracurium to maintain the depth of anesthesia.The incidences of POCD of both group were compaired and the scores of MMSE were esti-mated.Results:there were no difference in the age,gender,operation time,,intraoperative bleeding loss between the two groups(P>0..05).Thel-,4-,7-day postoperative inceidences of POCD in the D group were lower than those in the groupC(P<0.05).The1-,4-,7-day postoperative MMSE scores in the group D were signifcantly higher than those in the group C(P<0.05).Conclusion:For elderly patients with femoral neck fracture after surgery,taking dexmedetomidine hydrochloride anesthesia method can reduce the changce of cognitive function after surgery and helps to the incidence of POCD.