右美托咪定和丙泊酚对髋部骨折手术患者术后镇静效果及谵妄的影响  

Effect of Dexmedetomidin and Propofol on Postoperative Sedative Effect and Delirium in Patients Undergoing Hip Fracture Surgery

作　　者：邓超[1] 刘少星[1] 朱波[1] 罗亮[1] 谢先丰[1] DENG Chao;LIU Shao-xing;ZHU Bo;LUO Liang;XIE Xian-feng(Department of Anesthesiology,Chengdu Second People's Hospital,Chengdu,Sichuan,610016,China)

机构地区：[1]成都市第二人民医院麻醉科,四川成都610016

出　　处：《现代生物医学进展》2019年第3期552-555,共4页Progress in Modern Biomedicine

基　　金：四川省医学会科研课题(S16004)

摘　　要：目的:探讨右美托咪定和丙泊酚对髋部骨折手术患者术后镇静效果及谵妄改善效果的影响。方法:选取2016年4月-2018年3月于我院行髋部骨折手术的108例患者作为研究对象,按随机数字表法分为观察组(n=54)和对照组(n=54),两组患者术中均采用全身静脉麻醉,观察组患者给予右美托咪定进行镇静诱导,对照组患者给予丙泊酚进行镇静诱导。术后24h,采用Ramsay镇静评分评价两组患者术后的镇静效果,采用视觉模拟量表(VAS)评分评价术后镇痛效果,术后1周,对两组患者术后谵妄发生率、谵妄评定量表(CAM)评分、简易智能精神状态检查量表(MMSE)评分进行比较,记录不良反应发生情况。结果:术后24h,观察组患者的Ramsay镇静评分高于对照组,VAS评分及镇痛药追加量低于对照组,差异有统计学意义(P<0.05)。术后1周,观察组患者谵妄发生率、CAM评分低于对照组,MMSE评分高于对照组,差异有统计意义(P<0.05)。观察组不良反应发生率为9.26%,与对照组的14.81%比较,差异无统计学意义(P>0.05)。结论:与丙泊酚相比,髋部骨折手术患者应用右美托咪定可获得更好的术后镇静、镇痛效果,能够降低谵妄的发生率,且无严重不良反应发生,有较高的临床应用价值。Objective: To observe the effect of dexmedetomidin and propofol on postoperative sedative effect and delirium in patients undergoing hip fracture surgery. Methods: 108 patients who underwent hip fracture surgery in our hospital from April 2016 to March 2018 were selected as the research object. The patients were divided into the observation group (n=54) and the control group (n=54) according to the random number table, total body intravenous anesthesia was used in the two group, the patients in the observation group were given sedation induced by dexmedetomidine, the patients in the control group were given sedation induced by propofol. 24h after operation, Ramsay sedation score was used to evaluate the sedative effect of the two groups after operation, the visual analogue scale (VAS) score was used to evaluate the effect of postoperative analgesia. 1 week after operation, the incidence of postoperative delirium, delirium Rating Scale (CAM) score, mini mental state examination scale (MMSE) score were compared between the two groups. The occurrence of adverse reactions was recorded. Results: 24h after operation, the Ramsay sedation score in the observation group was higher than that in the control group, and the VAS score and the dosage of analgesics were lower than those in the control group, the differences were statistically significant (P<0.05). 1 weeks after the operation, the incidence of delirium in the observation group and the CAM score were lower than those in the control group, and the MMSE score was higher than that of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the observation group was 9.26%, compared with 14.81% of the control group, the difference was not statistically significant (P >0.05). Conclusion: Compared with propofol, dexmedetomidine can achieve better sedative, analgesic effects and reduce the incidence of delirium in patients with hip fracture surgery, there is no serious adverse reaction and high clinical value.

关 键 词：髋部骨折 右美托咪定 丙泊酚 镇静效果 谵妄 

分 类 号：R683[医药卫生—骨科学] R614[医药卫生—外科学]