右美托咪定对老年髋关节置换术患者术后镇静镇痛与谵妄的影响

Effects of dexmedetomidine on postoperative sedation analgesia and delirium in aged patients undergoing hip replacement surgery

目的观察老年髋关节置换术患者术后镇痛中应用右美托咪定对术后镇静镇痛与谵妄发生的影响。方法收集2018年8月到2019年8月宿迁市中医院接受髋关节置换手术后镇痛的老年患者60例,采用随机数字表法,随机分为右美托咪定组和无右美托咪定组,每组30例,其中右美托咪定组术中及术后镇痛泵中均加用右美托咪定,无右美托咪定组则否。比较两组术后各观察时点的Ramsay镇静评分、视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI)和谵妄发生率。结果右美托咪定组患者术后6、24、48 h Ramsay镇静评分均高于无右美托咪定组(P均<0.05);右美托咪定组患者术后1、6、24、48 h VAS评分均低于无右美托咪定组(P均<0.05);右美托咪定组患者术后第3日PSQI评分低于无右美托咪定组(P<0.001);右美托咪定组术后1~4 d谵妄总发生率为6.7%(2/30例),低于无右美托咪定组发生率26.7%(8/30例)(P=0.038)。结论在接受髋关节置换术治疗的老年患者术后镇痛中应用右美托咪定能够获得更好的镇静效果,改善患者术后睡眠质量,明显减少术后谵妄发生率。

Objective To analyze the effects of dexmedetomidine on incidence of postoperative sedation analgesia and delirium in aged patients undergoing hip replacement surgery.Methods Sixty aged patients undergoing hip replacement surgery from August 2018 to August 2019 in Traditional Chinese Medicine Hospital of Suqian City,were randomly divided into dexmedetomidine group(n=30)and non-dexmedetomidine group(n=30)by random number table.The patients were used dexmedetomidine during operation and postoperative analgesia in dexmedetomidine group,or were used not in non-dexmedetomidine group.Ramsay sedation score,visual analogue score(VAS),Pittsburgh sleep quality index(PSQI)and delirium incidence were compared between the two groups.Results The Ramsay sedation score was higher in the dexmedetomidine group than that in the non-dexmedetomidine group at 6,24 and 48 h after operation(all P<0.05),and VAS was lower at 1,6,24 and 48 h in the dexmedetomidine group than that in the non-dexmedetomidine group(all P<0.05).The PSQI was lower on the 3rd day after operation in the dexmedetomidine group than that in the non-dexmedetomidine group(P<0.001).The total incidence of delirium was 6.7%(2/30 cases)in the dexmedetomidine group on the 1st to 4th day after the operation,which was lower than that in the non-dexmedetomidine group 26.7%(8/30 cases)(P=0.038).Conclusion The application of dexmedetomidine during perioperative period could obtain better sedation,reduce postoperative pain,improve the postoperative sleep quality,and reduce significantly the incidence of postoperative delirium in aged patients undergoing hip replacement surgery.