摘要
目的研究右旋美托咪定对老年脊柱手术患者术后谵妄发生率的影响。方法 60例骨科老年脊柱手术患者,年龄65~75岁,随机均分为右旋美托咪定组(D组)和对照组(C组)。D组给予右旋美托咪定0.5μg/kg静脉泵注,15 min泵完;C组给予等量氯化钠注射液。记录患者入室时(T1)、右旋美托咪定或氯化钠注射液泵注后麻醉诱导前(T_2)、气管插管后(T_3)、术中放置骨科植入物时(T_4)、术毕拔除气管导管后(T_5)、出手术室(T_6)的收缩压(SBP)、舒张压(DBP)、心率(HR)。观察并记录两组患者术后10 min、6 h、24 h、48 h的Ramsay镇静评分和Price-Henry疼痛评分。采用谵妄评定法(CAM)评估术后谵妄发生率。记录术中药物的使用量、不良反应。结果与C组比较,D组患者舒芬太尼和丙泊酚用量均明显减少(P<0.05),D组T_4、T_5时的SBP、DBP明显下降,T_2、T_4、T_5时的HR明显减慢(P<0.05);但D组BP、HR值与T_1时比较差异未见统计学意义(P>0.05)。D组术后6、24、48 h的Ramsay镇静评分明显降低、Price-henry疼痛评分与C组比较明显降低(P<0.05)。D组有2例(6.7%)患者发生术后谵妄,明显低于C组的9例(33.3%,P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论老年脊柱手术患者术前给予0.5μg/kg右旋美托咪定可以降低术后谵妄的发生率而不增加不良反应。
Objective To evaluate the effects of dexmedetomidine on the incidence of postoperative delirium in elder patients with orthopaedic spinal surgery. Methods Sixty elder patients with orthopaedic spinal surgery,65-75 years old,were randomly divided into the dexmedetomidine group（ group D,0. 5 μg/kg,IV） and the control group（ group C）. Group D was treated with dexmedetomidine within 15 minute beforer induction of anaesthesia while group C received equal volume of normal saline. SBP,DBP and HR were continuously monitored at six different time which was baseline（ T1）,before induction of anaesthesia（ T2）,immediately after tracheal intubation（ T3）,placement of orthopaedic implants（ T4）,immediately after tracheal extubation（ T5）,leaving operation room（ T6）. Ramsay sedation scores,and Price-Henry pain score were recorded at 10 min,6 h,24 h,48 h after tracheal extubation in both groups. The incidence of postoperative delirium was evaluated by confusion assessment method（ CAM）. All kinds of total drug dosage and the incidence of side effect were recorded during the operation. Results Compared with group C,dosage of sufentanil and propofol in group D were decreased significantly（ P〈0. 05）. SBP and DBP at T4 and T5 were decreased obviously in group D（ P〈0. 05）. HR was slower significantly at T2,T4 and T5 in group D（ P〈0. 05）. But there was no difference in BP and HR between above each time and T1 in group D. PriceHenry pain score and Ramsay sedation score were significantly lower in group D at 6 h,24 h,48 h after tracheal extubation compared with group C（ P〈0. 05）. Two cases of postoperative delirium（ 6. 7%） in group C were less than 9 cases（ 33. 3%）in group D（ P〈0. 05）. The adverse reaction had no difference between the two groups（ P〈0. 05）. Conclusions Perfusing the dose of Dexmedetomidine 0. 5 μg/kg before induction could reduce the incidence of postoperative delirium without increasing the incidence of adverse reaction in elder patients with
出处
《临床医学》
CAS
2017年第8期54-57,共4页
Clinical Medicine
关键词
右旋美托咪定
脊柱手术
麻醉
术后谵妄
Dexmedetomidine
Spinal operation
Anesthesia
Postopretive delirium
