摘要
目的 探讨持续输入小剂量右美托咪定对老年髋关节置换术后谵妄的影响。方法 选取2018年1月至2018年10月在同济大学附属同济医院择期行髋关节置换术后入ICU的78例老年患者,随机分为右美托咪定组(A组)和生理盐水组(B组),每组39例。A组入ICU后立即给予持续静脉输入右美托咪定,速度为0.1 μg/(kg·h),直至24 h。B组给予同等剂量的生理盐水。观察2组患者术后24 h内的谵妄发生率;入ICU后即刻(T0)和入ICU后24 h(T1)外周血肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的变化情况;2组患者的夜间睡眠质量评分(NRS)和不良事件的发生情况。结果 A组患者的谵妄发生率(6/39,15.4%)明显低于B组(14/39,35.9%),差异有统计学意义(P<0.005)。2组患者T0时间点外周血TNF-α、IL-6和IL-8水平差异无统计学意义(P>0.05),T1时间点A组患者外周血TNF-α、IL-6和IL-8的浓度明显低于B组(P < 0.05);A组患者的夜间睡眠质量评分优于B组(P<0.05);2组患者不良事件的发生率差异无统计学意义(P>0.05)。结论 持续输入小剂量右美托咪定可以减少ICU老年患者髋关节置换术后谵妄的发生,减轻术后炎症反应,改善夜间睡眠质量,没有观察到明显的不良事件。
Objective To investigate the effects of continuous infusion of low-dose dexmedetomidine on postoperative delirium in elderly patients after hip replacement. Methods A total of 78 elderly patients who underwent elective hip replacement in our hospital from January 2018 to October 2018 were randomly divided into the dexmedetomidine group (group A) and the saline group (group B). 39 patients in each group. Group A was given continuous intravenous dexmedetomidine at a rate of 0.1 μg/(kg · h)until 24 hours. Group B was given the same dose of normal saline. We compared the incidence of postoperative delirium within 24 hours between the two groups. The results of serum tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-8 (IL-8) were measured immediately (T0) and 24 hours(T1)after ICU. Numeric rating scores for sleep quality (NRS) and incidence of adverse events were also evaluated. Results The incidence of delirium in group A (6/39, 15.4%) was significantly lower than that in group B (14/39, 35.9%)(P < 0.005). There were no significant differences between the results of TNF-α, IL-6 and IL-8 at T0 time(P > 0.05). The results of TNF-α, IL-6 and IL-8 in group A were significantly lower than those in group B (P < 0.05);The NRS in group A was better than group B (P < 0.05);there were no significant differences in the incidence of adverse events between the two groups(P > 0.05). Conclusion Continuous infusion of low-dose dexmedetomidine can reduce the incidence of postoperative delirium,improve nocturnal sleep quality in elderly patients after hip replacement, and no significant adverse events would be observed.
作者
王刚
张磊
周娟
郭涛
WANG Gang;ZHANG Lei;ZHOU Juan;GUO Tao(Dept. of Surgical Intensive Care Unit,Tongji Hospital of Tongji University;Dept. of Emergency Intensive Care Unit,Putuo District people's Hospital Affiliated to Tongji University,Shanghai 200060,China)
出处
《昆明医科大学学报》
CAS
2019年第9期106-109,共4页
Journal of Kunming Medical University
基金
上海市卫生和计划生育委员会科研基金资助项目(WSJ1809)
关键词
谵妄
右美托咪定
老年
术后并发症
Delirium
Dexmedetomidine
Elderly patient
Postoperative complications
