摘要
目的 探讨右美托咪定联合依达拉奉对老年全髋关节置换术患者术后谵妄的影响。方法 选取2013年6月至2016年6月于南京军区南京总医院择期行全髋关节置换术的老年患者98例，依据随机数表法分为联合组（32例）、右美托咪定组（29例）和对照组（37例）。联合组于麻醉诱导前静脉给予依达拉奉和右美托咪定，右美托咪定组单纯给予右美托咪定，对照组给予等量0.9%氯化钠注射液。术后1 d评估谵妄发生情况；术前及术后1 d分别评估简易精神状态评价量表（MMSE）和焦虑抑郁量表（HAD）评分；术后1 d检测炎性、氧化损伤及神经功能指标。结果 联合组术后1 d谵妄发生率［9.4%（3/32）］明显低于右美托咪定组［20.7%（6/29）］及对照组［35.1%（13/37）］，且右美托咪定组明显低于对照组（均P＜0.05）。术后1 d时，联合组MMSE评分最高［（25.6±1.7）分］，HAD-焦虑量表（A）及HAD-抑郁量表（D）评分最低［（8.2±1.4）分、（8.1±1.2）分］；对照组MMSE评分最低，HAD-A及HAD-D评分最高；3组间比较差异均有统计学意义（均P＜0.05）。联合组白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、丙二醛、神经元特异性烯醇化酶（NSE）水平最低［分别为（27.6±1.9）ng/L、（26±11）ng/L、（2.4±0.5）mmol/L、（6.2±1.8）μg/L］，超氧化物歧化酶（SOD）、还原型谷胱甘肽（GSH）水平最高［分别为（188±18）U/L、（365±44）U/L］；对照组IL-6、TNF-α、丙二醛、NSE水平最高，SOD、GSH水平最低；3组间比较差异均有统计学意义（均P＜0.05）。结论 右美托咪定联合依达拉奉可明显降低老年全髋关节置换术患者术后谵妄的发生率，其机制可能与氧化应激及炎性反应的抑制有关。
Objective To explore the effect of dexmedetomidine combined with edaravone on the occurrence of postoperative delirium（POD） in elderly patients after total hip arthroplasty（THA）. Methods A total of 98 elderly patients undergoing THA from June 2013 to June 2016 in Nanjing General Hospital of Nanjing Military Command were randomly divided into combination group（dexmedetomidine and edaravone, intravenously）, dexmedetomidine group and control group（equal volume 0.9% sodium chloride injection） with different drug treatments before anesthesia induction. The occurrence of POD was observed; Minimum Mental State Examination（MMSE） and Hospital Anxiety and Depression Scale（HAD） were assessed; inflammatory factors, oxidative stress and nerve function indexes were tested. Results There were significant differences of the 1 d incidence of POD among combination group, dexmedetomidine group and control group[9.4%（3/32） vs 20.7%（6/29） vs 35.1%（13/37）]（P〈0.05）. At 1 d after operation, MMSE score in combination group[（25.6±1.7）points] was higher, HAD-A and HAD-D scores[（8.2±1.4）,（8.1±1.2）points] were lower than those in dexmedetomidine group and control group; the control group had the lowest MMSE score and highest HAD-A and HAD-D scores; there were significant differences among groups（P〈0.05）. Levels of interleukin-6, tumor necrosis factor-α, malonaldehyde and neuronspecific enolase in combination group[（27.6±1.9）ng/L,（26±11）ng/L,（2.4±0.5）mmol/L,（6.2±1.8）μg/L] were lower, levels of superoxide dismutase and reduced glutathione hormone[（188±18）U/L,（365±44）U/L] were higher than those in dexmedetomidine group and control group; there were significant differences among 3 groups（P〈0.05）. Conclusion Dexmedetomidine combined with edaravone can significantly reduce the incidence of POD in elderly patients after THA; the possible mechanisms may be associated with the suppression on oxidative stress and inflammatory reactions.
出处
《中国医药》
2017年第8期1231-1234,共4页
China Medicine
关键词
股骨粗隆间骨折
右美托咪定
术后谵妄
Femoral intertrochanteric fracture
Dexmedetomidine
Postoperative delirium
