右美托咪定与硬膜外阻滞对老年全麻胃肠手术患者术后谵妄影响的比较  

A comparative study of dexmedetomidine and epidural anesthesia in reducing postoperative delirium in elderly patients undergoing general anesthesia with gastrointestinal surgery

作　　者：徐煌 顾尔伟[1] 王胜斌[2] XU Huang;GU Erwei;WANG Shengbin(Department of Anesthesiology,the first Affiliated Hospital,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230032 [2]安徽医科大学附属安庆医院麻醉科,安徽安庆246003

出　　处：《实用医学杂志》2018年第18期3101-3105,共5页The Journal of Practical Medicine

基　　金：安徽省科技攻关计划项目(编号:1301042204)

摘　　要：目的比较右美托咪定与硬膜外阻滞对老年全麻胃肠手术患者术后谵妄的影响。方法选择择期胃肠手术患者90例,年龄65~84岁,ASAⅠ~Ⅲ级,采用随机数字表法将患者分为3组(n=30)。A组为单纯全身麻醉组;B组为右美托咪定复合全身麻醉组;C组为硬膜外阻滞联合全身麻醉组。记录三组患者术中麻醉药物用量,手术、麻醉时间等一般情况以及术后48 h内VAS评分,观察患者术后1、2、3 d谵妄发生率,下床活动时间,首次通气时间,住院时间,住院期间及出院3个月内并发症的发生情况。结果与A组比较,B、C两组术中麻醉药物用量明显减少(P <0.05),术后谵妄发生率显著降低(P <0.05),住院时间明显缩短(P <0.05)。与B组比较,C组术中全麻药物使用量显著减少(P <0.01),术后首次通气时间明显缩短(P <0.05)。结论右美托咪定与硬膜外阻滞均可降低老年全麻胃肠手术患者术后谵妄发生率并缩短住院时间,两者之间比较无明显区别。Objective To investigate the effect of dexmedetomidine combined with general anesthesia on the incidence of postoperative delirium in elderly patients undergoing general anesthesia with gastrointestinal sur-gery,in comparing with epidural block combined with general anesthesia.Methods Ninety patients undergoing elective gastrointestinal surgery,aged 65~84 years,were randomly divided into the general anesthesia group(Group A),dexmedetomidine combined with general anesthesia group(Group B)and the epidural block com-bined with general anesthesia(Group C),with 30 cases in each group.The dosage of general anesthesia drugs,the time of the operation and anesthesia were recorded.The value of VAS score within 48 h after surgery was record-ed.The incidence of postoperative delirium at 1,2,3 d after surgery was evaluated by the confusion assessment method(CAM).The recovery time of resume normal activities,gastrointestinal function,hospital stay,the compli-cations during hospitalization and at 3 months after surgery were recorded.Results Compared with group A,the dosage of general anesthetics was significantly decreased in group B and group C(P<0.05,respectively),the in-cidence of postoperative delirium in group B and group C was lowered,as well as the shorten hospital stay(P<0.05,respectively).Compared with group B,the dosage of general anesthetics was significantly decreased in group C(P<0.01),the recovery time of gastrointestinal function in group C was significantly shortened(P<0.05).Conclusion Both dexmedetomidine and epidural block can reduce the incidence of delirium and shorten hospital-ization time in elderly patients undergoing general anesthesia with gastrointestinal surgery,but with no significant difference between them.

关 键 词：硬膜外阻滞 右美托咪定 老年患者 术后谵妄 胃肠道手术 

分 类 号：R614.2[医药卫生—麻醉学]