右美托咪定对老年股骨颈骨折手术患者术后苏醒质量及谵妄的影响

Effect of Dexmedetomidine on Postoperative Recovery Quality and Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

目的探讨右美托咪定在老年股骨颈骨折手术患者中的应用效果。方法选择2021年1月-2022年12月我院收治的80例老年股骨颈骨折手术患者,根据随机数字表法将其分为对照组和研究组,每组40例。两组均予以全身麻醉下行股骨颈骨折手术,对照组于麻醉诱导前经静脉泵入0.5μg/kg生理盐水,研究组于麻醉诱导前经静脉泵入0.5μg/kg右美托咪定。比较两组术后呼吸恢复时间、睁眼时间及拔管时间,比较两组术前、术后第3天血清P物质(SP)、去甲肾上腺素(NE)水平及简易精神状态检查表(MMSE)评分,统计患者术后谵妄及不良反应发生情况。结果研究组术后呼吸恢复时间、睁眼时间及拔管时间均短于对照组,差异有统计学意义(P<0.05);两组术后第3天血清SP及NE水平均高于术前,且研究组低于对照组,差异有统计学意义(P<0.05);两组术后MMSE评分均低于术前,且研究组高于对照组,差异有统计学意义(P<0.05);研究组术后谵妄发生率低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定可改善老年股骨颈骨折手术患者术后苏醒质量及镇痛效果,对于患者认知功能的影响较小,可降低术后谵妄发生风险,且不会增加不良反应。

Objective To investigate the application effect of dexmedetomidine in elderly patients undergoing femoral neck fracture surgery.Methods A total of 80 elderly patients with femoral neck fracture treated in our hospital from January 2021 to December 2022 were selected and divided into control group and study group according to the random number table method,with 40 patients in each group.Both groups were given femoral neck fracture surgery under general anesthesia.The control group was intravenously pumped with 0.5μg/kg normal saline before anesthesia induction,and the study group was intravenously pumped with 0.5μg/kg dexmedetomidine before anesthesia induction.The postoperative respiratory recovery time,eye opening time and extubation time were compared between the two groups.The levels of serum substance P(SP),norepinephrine(NE)and mini-mental state examination(MMSE)scores were compared between the two groups before and 3 days after operation.The incidence of postoperative delirium and adverse reactions were statistically analyzed.Results The postoperative respiratory recovery time,eye opening time and extubation time in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The levels of serum SP and NE in the two groups at 3 days after operation were higher than those before operation,and those in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).The MMSE score of the two groups after operation was lower than that before operation,and that in the study group was higher than that in the control group,the difference was statistically significant(P<0.05).The incidence of postoperative delirium in the study group was lower than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine can improve the postoperative recovery quality and analgesic effect of elderly patients undergoing femoral neck fracture surgery.Meanwhile,tt has little effect on the cognitive function of patients,can reduce the risk of postoperative delirium,and will not increase adverse reactions.