腰硬联合麻醉术中持续静脉泵注右美托咪啶对老年骨科手术患者术后谵妄改善情况的对比观察

Comparative observation of continuous intravenous Infusion of Dexmedetomidine during combined spinal-epidural Anesthesia in improving postoperative Delirium in elderly Patients undergoing orthopedic Surgery

目的对比观察腰硬联合麻醉术中持续静脉泵注右美托咪啶对老年骨科手术术后谵妄改善情况。方法选择2019年9月至2020年2月江苏省太仓市中医医院收治的52例实施腰硬联合麻醉手术的老年骨手术患者为研究对象,采用随机分组法将其分为观察组和对照组,各26例。观察患者给予持续性静脉泵注右美托咪啶,对照组患者给予生理盐水,对比两组患者血流动力变化、药物治疗效果及术后谵妄病症发生率。结果观察组患者心动过缓发生率显著高于对照组,且阿托品药物使用例数也显著多于对照组,差异有统计学意义(P<0.05)。观察组患者低血压、高血压发生率与对照组对比,差异无统计学意义(P>0.05)。观察组患者使用苯肾上腺素与硝酸甘油剂量与对照组对比,差异无统计学意义(P>0.05)。观察组患者术后谵妄发生率(30.77%)显著低于对照组谵妄发生率(61.54%),差异有统计学意义(P<0.05)。结论腰硬联合麻醉术中持续静脉泵注右美托咪啶对老年骨科手术患者术后谵妄改善临床效果显著。

Objective To observe the effect of continuous intravenous infusion of dexmedetomidine in combined spinal-epidural anesthesia on postoperative delirium in elderly patients undergoing orthopedic surgery.Methods A total of 52 elderly patients undergoing orthopedic surgery under combined spinal-epidural anesthesia from September 2019 to February 2020 in Taicang Hospital of traditional Chinese medicine were divided into observation group(N=26)and control group(N=26)according to the random number table,the observation group was given dexmedetomidine by continuous intravenous pump,and the control group was given normal saline.The changes of hemodynamic,the effect of drug treatment and the incidence of postoperative delirium were compared between the two groups.Results The incidence of bradycardia in the observation group was significantly higher than that in the control group,and the use of atropine in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in the incidence of hypotension and hypertension between the observation group and the control group(P>0.05).Similarly,There was no significant difference in the dosage of phenylephrine and nitroglycerin in the two group.the incidence of postoperative delirium in the observation group(30.77%)was significantly lower than that in the control group(61.54%)(P<0.05).Conclusion Continuous intravenous infusion of dexmedetomidine during combined spinal-epidural anesthesia is effective in improving postoperative delirium in elderly patients undergoing orthopedic surgery.