不同吸入浓度的七氟烷联合瑞芬太尼对髋关节置换术老年患者术后谵妄的影响  

Effects of different concentrations of inhaled sevoflurane combined with remifentanil on postoperative delirium in elderly patients undergoing hip replacement

作　　者：陆文敏[1] 林宗航[1] 黄雪芳 李雪梅 张斌[1] 付宝军[1] 张雪影 李恒[1] LU Wenmin; LIN Zonghang; HUANG Xuefang; LI Xuemei; ZHANG Bin; FU Baojun; ZHANG Xueying;LI Heng(Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University （Qingyuan People＇s Hospital）, Qingyuan , Guangdong 511518, China)

机构地区：[1]广州医科大学附属第六医院(清远市人民医院)麻醉科,广东清远511518

出　　处：《岭南现代临床外科》2018年第5期540-543,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省清远市科技计划项目(2016B029)

摘　　要：目的观察吸入不同浓度的七氟烷联合瑞芬太尼对接受髋关节置换手术老年患者术后谵妄的影响。方法本课题纳入我院接受髋关节置换手术的老年患者100例,将入选患者分为2组:低浓度组(L组)和高浓度组(H组),每组50名患者。L组的七氟烷吸入浓度为1.5%,H组的七氟烷吸入浓度为3%。术前1 d、术后1 d、术后2 d和术后3 d使用谵妄评定量表中文修订版(CAM-CR)评估谵妄发生情况;分别于麻醉诱导前(T0)、术后1 h(T1)、术后6 h(T2)、术后1 d(T3)抽取外周静脉血,用ELISA法检测S100β蛋白的浓度。结果 H组术后3 d内的POD总发生率明显高于L组(P<0.05),H组T1、T2的S100β蛋白水平明显高于L组(P<0.05),复苏时间明显延长(P<0.05)。结论吸入3%的七氟烷联合瑞芬太尼可导致接受髋关节置换术老年患者术后谵妄的发生率增高,吸入1.5%的七氟烷联合瑞芬太尼的麻醉方式具有较高的安全性。Objective To observe the effect of inhaling different concentrations of sevoflurane on postoperative delirium in elderly patients undergoing hip replacement surgery. Methods In this respective research, 100 elderly patients, aged 65 to 75 years and more than 6 years of education, were performed the hip arthroplasty in our hospital. The grouped patients were assigned to two groups, low concentration group （group L） and high concentration group （group H） , with 50 patients in each group. The concentration of sevoflurane inhalation in the L group was 1.5% , and the sevoflurane inhalation concentration in the H group was 3%. Chinese revised version of delirium assessment scale （CAM-CR） was used to assess the incidence of delirium in the preoperative day 1, postoperative day 1, postoperative day 2, and postoperative day 3. Peripheral venous blood was taken before anesthesia induction （To） , 1 h postoperatively （T,） , 6 h postoperatively （%） , 1 day postoperatively （T3） extraction of peripheral venous blood for detecting the concentration of S10013 protein. Results The total incidence of postoperative delirium （POD） in 3 days after operation in group H was significantly higher than that in group L （P〈0.05）. The S10013 protein level of T, and T2 in group H was significantly higher than that in L group （ P〈0.05 ） , and the time of recovery was obviously prolonged （P〈0.05）. Conclusions The 3% concentration of sevoflurane inhaled combined with remifentanil could lead to an increase in the incidence of POD in the elderly patients undergoing hip replacement. 1.5% sevoflurane inhalation combined with remifentanil has higher safety.

关 键 词：七氟烷 吸入浓度 老年患者 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]