术前用药对老年患者髋关节置换术后谵妄发生率的影响  

The Influence of Premedication on Postoperative Delirium of Elderly Patients with Hip Replacement

作　　者：李忆鲁[1] 万小健[2] 孔宁[1] 

机构地区：[1]上海市第一人民医院分院ICU,上海200081 [2]第二军医大学附属长海医院ICU,上海200433

出　　处：《中国临床医学》2008年第3期387-388,共2页Chinese Journal of Clinical Medicine

摘　　要：目的:观察术前给予阿托品及咪达唑仑对老年患者髋关节置换术后谵妄的影响。方法:将99例髋关节置换的老年患者随机分为4组,术前分别予肌注阿托品(A组)、口服咪达唑仑(M组)、口服咪达唑仑+肌注阿托品(A+M组)、肌注0.9%NaCl液(C组),观察患者手术时间、术中出血量、输血量、低血压时间、术后疼痛数字评分及芬太尼用量,并且术后4d内评估患者是否发生谵妄。结果:各组患者在年龄、性别、ASA分级,手术时间、出血量、输血量、低血压时间、术后疼痛数字评分及芬太尼用量上无明显区别,但A组与A+M组的谵妄发生率明显高于C组和M组(P>0.05)。结论:术前常规应用阿托品可能会增加老年髋关节置换患者术后谵妄的发生率,同时,术前给予咪达唑仑口服并不能减少谵妄的发生率。Objective：To observe the influence of premedication with atropine and midazolam on postoperative delirium of old patients with hip replacements.Methods：Total of 99 old patients were randomly divided into four groups：group A were injected atropine intramuscularly,group M were administrated midazolam orally,group A＋M were injected atropine intramuscularly and administrated midazolam orally,while group C were injected normal saline intramuscularly.Operation time,volume of blood loss and transfusion,the lasting time of hypotention,postoperative numeral assessment of pain and the dosage of fentanyl administrated postoperatively were recorded.Every patient was assessed according to criteria of delirium in 4 days after operation.Results：Among four groups,there is no difference in age,sex,ASA assessment,surgery time,voleme of blood loss and transfusion,the lasting time of hypotention,postoperative numeral assessment of pain,and the dosage of fentanyl used postoperatively.However,compared with group C and Group M,there were more patients suffering from delirium in group A and group A＋M（P〈0.05）.Conclusions：Premedication with atropine regularly may increase the incidence of postoperative delirium in old patients with hip replacements.In addition,premedication with midazolam could not decrease the incidence of postoperative delirium.

关 键 词：阿托品 咪达唑仑 老年患者 髋关节置换 谵妄 

分 类 号：R749.4[医药卫生—神经病学与精神病学]