右美托咪定联合小剂量奥氮平对骨科全身麻醉老年患者术后谵妄的影响

Effect of dexmedetomidine combined with low-dose olanzapine on postoperative delirium in elderly patients undergoing orthopaedic operation under general anesthesia

目的探讨右美托咪定联合小剂量奥氮平对骨科全身麻醉老年患者术后谵妄的影响。方法选择2019年9月至2020年2月于南通市第一人民医院接受全身麻醉下骨科手术的80例老年患者为研究对象,采用随机数字表法将患者分为观察组与对照组,每组40例。2组患者入手术室后均给予右美托咪定1μg·kg^(-1),静脉滴注,滴注速度为1μg·kg^(-1)·h^(-1),10 min后滴注速度调整为0.2~0.4μg·kg^(-1)·h^(-1),持续静脉滴注,直至Richmond躁动-镇静评分为0分时停用。在此基础上,观察组患者清醒后给予奥氮平片2.5 mg,每日1次,持续应用1周。观察2组患者术后谵妄发生率及持续时间,采用简易智力状态检查量表(MMSE)评估患者术前24 h及术后24、48、72 h认知功能,采用酶联免疫吸附试验测定患者术前及术后24 h血清中5-羟色胺(5-HT)、多巴胺(DA)水平。结果观察组和对照组患者术后谵妄发生率分别为5.00%(2/40)、27.50%(11/40),谵妄持续时间分别为(4.12±0.65)、(4.51±0.72)d;观察组患者术后谵妄发生率显著低于对照组(P<0.05),但2组患者谵妄持续时间比较差异无统计学意义(P>0.05)。术前2组患者MMSE评分比较差异无统计学意义(P>0.05);对照组患者术后24、48、72 h时MMSE评分显著低于术前(P<0.05);观察组患者术后24 h时MMSE评分显著低于术前(P<0.05),术后48、72 h时MMSE评分与术前比较差异无统计学意义(P>0.05);术后24、48、72 h,观察组患者MMSE评分显著高于对照组(P<0.05)。术前2组患者血清5-HT、DA水平比较差异无统计学意义(P>0.05),2组患者术后24 h时血清5-HT、DA水平显著低于术前(P<0.05);术后24 h,观察组患者血清5-HT、DA水平显著低于对照组(P<0.05)。结论右美托咪定联合小剂量奥氮平可以显著降低骨科全身麻醉老年患者术后谵妄发生率,改善患者术后认知功能。

Objective To investigate the effect of dexmedetomidine combined with low-dose olanzapine on postoperative delirium in elderly patients undergoing orthopaedic operation under general anesthesia.Methods A total of 80 elderly patients who underwent orthopaedic operation under general anesthesia in the First People's Hospital of Nantong City from September 2019 to February 2020 were selected as the research subjects,and the patients were divided into observation group and control group by using random number table,with 40 cases in each group.After entering the operating room,the patients in both groups were given dexmedetomidine 1μg·kg^(-1) intravenously at a rate of 1μg·kg^(-1)·h^(-1),after 10 minutes,the infusion rate was adjusted to 0.2-0.4μg·kg^(-1)·h^(-1) until the Richmond agitation and sedation scale score was 0.On this basis,the patients in the observation group were given olanzapine tablets 2.5 mg once a day for 1 week after waking up.The incidence and duration of postoperative delirium of patients in the two groups were observed.The cognitive function of patients were evaluated by mini-mental state examination(MMSE)at 24 hours before operation and 24,48 and 72 hours after operation.The levels of serum 5-hydroxytryptamine(5-HT)and dopamine(DA)were measured by enzyme-linked immunosorbent assay before operation and 24 hours after operation.Results The incidence of postoperative delirium in the observation group and the control group was 5.00%(2/40)and 27.50%(11/40),and the delirium duration was(4.12±0.65)and(4.51±0.72)days,respectively.The incidence of postoperative delirium in the observation group was significantly lower than that in the control group(P<0.05),but there was no significant difference in delirium duration between the two groups(P>0.05).There was no significant difference in the MMSE score between the two groups before operation(P>0.05).The MMSE scores of patients in the control group at 24,48 and 72 hours after operation were significantly lower than those before operation(P<0.05).The MMSE score of patients in the observation group at 24 hours after operation was significantly lower than that before operation(P<0.05),but there was no significant difference in the MMSE score between 48,72 hours after operation and before operation(P>0.05).The MMSE score in the observation group was significantly higher than that in the control group at 24,48 and 72 hours after operation(P<0.05).There was no significant difference in the levels of serum 5-HT and DA between the two groups before operation(P>0.05).The levels of serum 5-HT and DA at 24 hours after operation were significantly lower than those before operation in the two groups(P<0.05).The levels of serum 5-HT and DA in the observation group were significantly lower than those in the control group at 24 hours after operation(P<0.05).Conclusion Dexmedetomidine combined with low-dose olanzapine can significantly reduce the incidence of postoperative delirium and improve postoperative cognitive function in elderly patients undergoing orthopaedic operation under general anesthesia.