右美托咪定对老年非心脏大手术患者苏醒期及术后谵妄的影响  

Effects of Dexmedetomidine on the Incidence of Emergence Delirium and Postoperative Delirium in the Elderly after noncardiac surgery

作　　者：张静[1] 胡晓云[1] 关雷[1] 刘鹏飞[1] 赵斌江[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院,北京100038

出　　处：《中国实验诊断学》2015年第6期924-926,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨全身麻醉中应用右美托咪定(dexmedetomidine,DEX)是否可减低老年患者非心脏大手术后苏醒期谵妄及术后谵妄的发生率。方法选取2012年1月至2013年12月北京世纪坛医院60岁以上ASA I-III级实施肿瘤(胸腔、腹腔及泌尿系统)切除手术的老年患者206例(无抑郁症及精神病史),随机分为2组:右美托咪定组(D组99例)与对照组(C组107例),记录:两组苏醒期谵妄评估、躁动镇静评分;观察两组术后第1-3天谵妄发生情况,行意识状态评定方法评估及术中情况。结果 D组发生苏醒期谵妄8例(8.1%),术后谵妄4例(4.0%);C组发生苏醒期谵妄25例(23.4%),术后谵妄15例(15.5%)。发生苏醒期谵妄的33例病例中有17例出现了术后谵妄(POD,51.5%),未发生苏醒期谵妄的173例中发生了2例POD(1.2%),前者POD的发生率显著高于后者。结论右美托咪定可以降低老年非心脏大手术患者苏醒期谵妄及术后谵妄的发生率,发生苏醒期谵妄的老年患者更易发生术后谵妄。Objective To observe if dexmedetomidine for non-cardiacsurgery had the effect that decreasing the incidence rate of the emergence delirium and the postoperative delirium（POD）.To investigate the relation between the emergence delirium and the postoperative delirium.Methods There were 206 enrolled patients,depleting the patient who had acute massive haemorrhage,drastic fluctuation and accessed to ICU after operation or rejected to interview.Those patients were allocated into two groups randomly：group D（dexmedetomidine,n=99）and group C（control group,n=107）.The same interviewer evaluated the patients for emergence delirium by the Nursing Delirium Screening Scale（NuDESC）,and Richmond Agitation-Sedation Scale（RASS）in post-anesthetic care unit;and evaluated postoperative delirium by the Confusion Assessment Method（CAM）during the first 3postoperative days;evaluated postoperative cognitive dysfunction by the Mini-Mental State Examination（MMSE）,cognitive state examination and Back Depression Inventory（BDI）before the operation and repeated it at 7days postoperatively.Other information were also monitored.Results The incidence of emergence delirium in group D was 8.1%,POD was 4.0%;and the incidence of emergence delirium in group C was 23.4%,POD was 15.5%.The incidence of POD in emergence delirium patient is 51.5%,but without emergence delirium is 1.2%,so the former is significantly higher than the latter.Conclusion Eexmedetomidine for non-cardiac surgery had the effect that decreased the incidence rate of the emergence delirium and the postoperative delirium.The emergence delirium was prone to the postoperative delirium.

关 键 词：右旋美托咪啶 苏醒期谵妄 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]