血氧分压结合其它临床指标在瑞芬太尼联合右美托咪定对老年全髋关节置换术后谵妄患者的临床研究中的作用

Role of partial oxygen pressure and other clinical indications in treatment of remifentanil and dexmedetomidine in elderly patients after total hip arthroplasty

目的研究血氧分压(PO_(2))结合其它临床指在瑞芬太尼联合右美托咪定对全髋关节置换术后发生谵妄的老年患者治疗的安全性和有效性研究中的作用。方法选择2021年1月至2022年3月期间入住河南省人民医院重症监护病房的老年全髋关节置换出现谵妄的患者,随机分为两组,治疗组应用盐酸瑞芬太尼[(2.8~5.6)μg/(kg·h)]联合盐酸右美托咪定[(0.14~0.56μg/(kg·h)],对照组给予咪达唑仑(1~2 mg/h)镇静治疗,持续静脉微量泵泵入48 h,两组均维持镇静目标Ramsay评分2~4分,重症监护疼痛观察(CPOT)评分达到0~3分,观察治疗前和治疗后2、6、12、24、24 h两组镇痛镇静效果,以及患者的平均动脉血压(MAP)、心率(HR)、呼吸频率(RR)、血氧分压(PO_(2))、Ramsay分级和CPOT评分,谵妄的总缓解率;比较两组的镇静镇痛达标时间和不良反应发生情况,结果随着治疗时间延长,两组给药各时间点CPOT评分Ramsay评分、MAP、HR、RR均较给药前明显降低,比较差异均无统计学意义(P>0.05)血氧分压(PO_(2))明显高于对照组(P<0.05),治疗组镇静镇痛达标时间较对照组明显缩短(P<0.05),总有效率治疗组明显高于对照组93.2%,66.1%对比P<0.05,不良反应发生率较对照组明显降低[治疗组8.4%(5/59)比对照组20.3%(12/59),P<0.05]。结论血氧分压在瑞芬太尼联合右美托咪啶应用于重症监护室全髋关节置换术后出现谵妄的老年患者中有较好的临床指导作用,病人能较快达到镇静目的和被唤醒,在血气指标改善和唤醒方面优于咪达唑仑,血流动力学稳定,无呼吸抑制,且不良反应发生率更低。

Objective To study the role of partial oxygen pressure(PO_(2))and other clinical indications in the treatment of remifentanil and dexmedetomidine in elderly patients after total hip arthroplasty.Methods Select the elderly patients with total hip replacement who were admitted to the intensive care unit of Henan Provincial People's Hospital from January 2021 to March 2022,they were randomized into two groups,In the treatment group,romifentanil hydrochloride[(2.8~5.6)μg/(kg·h)]combined with dexmedetomidine hydrochloride[(0.14~0.56μg/(kg·h)],the control group was sedated with midazolam(1mg/h-2mg/h),continuous venous micropump pumping for 48 hours,both groups maintained the sedation target Ramsay score of 2-4,Intensive Care Pain Observation(CPOT)score of 0-3,the effect of analgesia and sedation in both groups before and 2,6,12,24 and 24h after treatment,and their mean arterial blood pressure(MAP),heart rate(HR),respiratory rate(RR),partial oxygen pressure(PO_(2)),Ramsay grade and CPOT score,false total remission rate;Comparing the standard time of sedation and analgesia and the occurrence of adverse reactions between the two groups.Results That along with longer treatment time,CPOT score Ramsay score,MAP,HR,and RR were significantly lower in both groups compared with those before administration,No statistical difference(P>0.05),the blood oxygen partial pressure(PO_(2))was significantly higher than that of the control group(P<0.05),the standard time of sedation and analgesia in the treatment group was significantly shorter compared with that of the control group(P<0.05),the total effective rate treatment group was significantly higher than that of the control group 93.2%,66.1%for contrast,P<0.05,The incidence of adverse reactions was significantly lower compared with than that of the control group[8.4%(5/59)of the treatment group vs 20.3%(12/59)of the control group,P<0.05].Conclusion Blood oxygen partial pressure in remifentanil and dexmedetomidine in elderly patients with good clinical guidance,patients can quickly achieve sedation and awakening,better than midazolam in blood gas index improvement and awakening,stable hemodynamic,no respiratory depression,and lower incidence of adverse reactions.