目的 探讨盐酸右美托咪定对老年髋部骨折患者术后谵妄的影响。方法 选择在腰硬联合麻醉下择期行股骨粗隆间骨折髓内钉固定术81例,股骨颈骨折闭合复位内固定术55例,随机将患者分为盐酸右美托咪定组(69例)和对照组(67例),前者入ICU后20 min内给予盐酸右美托咪定持续静脉泵入,后者在相同时间内应用等量生理盐水,记录术后不同时点患者静脉自控镇痛(PCIA)应用情况,根据目测疼痛评分法(VAS)进行疼痛评分,记录Ramsay镇静评分,采用精神错乱评估法(CAM-ICU)诊断谵妄,观察谵妄发生率。结果 两组患者在入ICU即刻、术后6 h、12 h,静脉自控镇痛泵的总按压次数、有效按压次数、用药量、SpO2和术后疼痛评分比较,差异均无统计学意义;盐酸右美托咪定组患者术后6 h、12 h心率和平均动脉压低于对照组,镇静评分高于同时间点对照组,盐酸右美托咪定组术后8~12 h CRP值低于对照组,6 h及12 h内睡眠时间长于对照组,差异均有统计学意义(P＜0.05);盐酸右美托咪定组术后12 h内出现谵妄7例(10.14%),对照组20例(29.85%),盐酸右美托咪定组谵妄发生率低于对照组,差异有统计学意义(P＜0.05)。结论 术后静脉持续输注盐酸右美托咪定可降低老年髋部骨折患者术后12 h内谵妄的发生率。
Abstract
Objective To explore the effect of dexmetomidine on postoperative delirium in elderly patients with hip fracture.Methods One hundred and thirty-six postoperative patients with hip fracture and above 65 years old were randomly divided into 2 groups:dexmedetomidine group(n=69)and normal group (n=67).In dexmedetomidine group, the patients received dexmedetomidine by intravenous continuous infusion at 0.2 μg/(kg·h) within 20 minutes of their admission to the ICU.PCIA、VAS pain scores、 Ramsay sedation scores and the incidence of deliriumu were recorded at different time points after surgery.CAM-ICU was used to diagnose delirium.Results The total number of presses by PCIA, number of effective presses, drug consumption, SPO2 and postoperative pain scores of these patients were not significantly different upon their admission to the ICU, 6 h and 12 h after surgery(P>0.05). Heart rate and MAP in the dexmedetomidine group were lower than in the normal group, but sedation scores were higher at the same time point and 6 h and 12 h after admission to the ICU. CRP was lower and hours of sleep were longer in the dexmedetomidine group than in the normal group. There were 7 cases of postoperative delirium (10.14%)in the dexmedetomidine group, but 20 cases (29.85%)in the normal group 12 hours after surgery. The difference between the two groups was statistically significant (P<0.05).Conclusions Continuous intravenous infusion of dexmetomidine can reduce the incidence of postoperative delirium in elder patients with hip fracture.
关键词
盐酸右美托咪定 /
老年患者 /
镇痛镇静 /
术后谵妄
Key words
dexmedetomidine /
elderly patient /
analgesic and sedative /
postoperative delirium
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