摘要
目的 分析右美托咪定(dexmedetomidine,DEX)联合七氟醚对人工全膝关节置换术(total knee arthroplasty,TKA)患者苏醒期躁动(emergence agitation,EA)及术后认知功能障碍(postoperative cognitive dysfunction,POCD)的功能影响。方法纳入2019年10月至2021年12月明光市中医院骨科住院部收治的接受TKA患者临床资料169例,按照麻醉方式分为联合麻醉组(n=85,DEX+七氟醚)及七氟醚组(n=84,七氟醚),观察两组手术时间、术中出血量、麻醉苏醒时间、呼吸恢复时间及拔管时间等,采用Riker镇静-躁动评分法(sedation-agitation scale,SAS)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、意识模糊评估法(confusion assessment method,CAM)评估两组EA、POCD及其他术后不良事件发生情况。结果 联合麻醉组麻醉苏醒时间、呼吸恢复时间及拔管时间均低于七氟醚组(P <0.05)。联合麻醉组罗库溴铵、瑞芬太尼术中用量少于七氟醚组(P <0.05)。联合麻醉组5例患者出现EA,低于七氟醚组的13例,差异有统计学意义(P <0.05)。联合麻醉组SAS评分小于七氟醚组,差异有统计学意义(P <0.01)。术后D1,联合麻醉组MoCA评分大于七氟醚组,差异有统计学意义(P <0.001)。联合麻醉组术中低血压、心动过缓发生率高于七氟醚组,而POCD发生率低于七氟醚组,差异有统计学意义(P<0.05)。结论 DEX联合七氟醚可有效降低TKA患者EA发生率及不良事件发生率,改善术后认知功能。
Objective To analyze the effects of dexmedetomidine(DEX)combined with sevoflurane on emergence agitation(EA)and postoperative cognitive dysfunction(POCD)in patients with total knee arthroplasty(TKA).Methods Clinical data of 169 TKA patients admitted to the department of orthopedics,Mingguang hospital of traditional Chinese medicine from October 2019 to December 2021 were included.According to the anesthesia method,they were divided into combined anesthesia group(n=85,DEX+sevoflurane)and sevoflurane group(n=84,sevoflurane).The operation time,intraoperative blood loss,anesthesia recovery time,respiratory recovery time and extubation time of the two groups were observed.Riker sedation-agitation scale(SAS),Montreal cognitive assessment(MoCA)and confusion assessment method(CAM)were used to evaluate EA,POCD and other postoperative adverse events in the two groups.Results The anesthesia recovery time,respiratory recovery time and extubation time of the combined anesthesia group were significantly lower than those of the sevoflurane group(P<0.05).The amount of rocuronium bromide and remifentanil in combined anesthesia group was less than that in the sevoflurane group(P<0.05).Five patients in the combined anesthesia group showed EA,which was lower than that in the sevoflurane group(13 cases),and the difference was statistically significant(P<0.05).The SAS score of the combined anesthesia group was lower than that of the sevoflurane group,and the difference was statistically significant(P<0.01).The MoCA score of combined anesthesia group was higher than that of sevoflurane group on D1 after surgery,and the difference was statistically significant(P<0.001).The incidence of hypotension and bradycardia in combined anesthesia group was higher than that in sevoflurane group,while the incidence of POCD was lower than that in sevoflurane group,and the difference was statistically significant(P<0.05).Conclusion DEX combined with sevoflurane can effectively reduce the incidence of EA and adverse events in patients with TKA,and impr
作者
郭小舟
采国兵
GUO Xiaozhou;CAI Guobing(Department of Anesthesiology,Mingguang Hospital of Traditional Chinese Medicine,Chuzhou 239499,Anhui Province,China;Department of Orthopedics,Mingguang Hospital of Traditional Chinese Medicine,Chuzhou 239499,Anhui Province,China)
出处
《世界临床药物》
CAS
2023年第4期344-348,396,共6页
World Clinical Drug
