不同剂量右美托咪定联合舒芬太尼对老年髋关节置换患者术后功能恢复与谵妄的影响  

Effects of different doses of dexmedetomidine combined with sufentanil on postoperative functional recovery and delirium in elderly patients undergoing hip replacement

作　　者：彭蓓[1] 彭志勇 郑利民[1] 罗涛[1] 王立昌[1] PENG Bei;PENG Zhi-yong;ZHENG Li-min;LUO Tao;WANG Li-chang(Department of Anesthesiology,Shenzhen Hospital,Peking University,Shenzhen 518100,China;Department of Anesthesiology,Southern Medical University Shenzhen Hospital,Shenzhen 518100,China)

机构地区：[1]北京大学深圳医院麻醉科,广东深圳518100 [2]南方医科大学深圳医院麻醉科,广东深圳518100

出　　处：《实用药物与临床》2019年第5期485-488,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨不同剂量右美托咪定复合舒芬太尼麻醉对老年患者髋关节置换术术后功能恢复及谵妄的影响。方法选择2012年12月至2016年12月在我院治疗的老年髋关节置换术患者150例作为研究对象,根据信封随机抽签原则分为A0、A1、A2、A3不同剂量右美托咪定组和对照组,每组30例。右美托咪定组采用右美托咪定负荷剂量1.0μg/kg,A0、A1、A2、A3组的输注速率分别为0、0.3、0.5、0.7μg/(kg·h),对照组患者采用等容量生理盐水进行处理。记录各组的术后恢复情况及认知功能情况。结果 A0、A1、A2、A3组术中舒芬太尼平均浓度及术中30 min时中心动脉压均显著降低(P<0.05);A2、A3组患者恢复自主呼吸所用时间、开始呼叫到睁开眼睛时间显著延长(P<0.05);与对照组、A0组相比,术后第1天A1、A2、A3组患者MMSE得分较高(P<0.05);与对照组、A0组患者相比,术后A1、A2、A3组患者谵妄发生率较低(P<0.05);A1、A2组患者术后14 d呼吸抑制、低血压、高血压、心动过缓等不良反应发生率明显降低(P<0.05)。结论以1.0μg/kg为右美托咪定负荷剂量,并以0.3μg/(kg·h)速率输注复合舒芬太尼麻醉,可降低老年髋关节置换术后谵妄的发生率,在促进患者苏醒的基础上可以减少不良反应的发生。Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanil on postoperative functional recovery and delirium in elderly patients undergoing hip arthroplasty.Methods A total of 150 elderly patients undergoing hip arthroplasty in our hospital from December 2012 to December 2016 were selected as the subjects.They were divided into A0,A1,A2 and A3 groups with different doses of dexmedetomidine and control group,30 cases in each group.The loading dose of dexmedetomidine was 1.0μg/kg in dexmedetomidine group,and the infusion rates of A0,A1,A2 and A3 groups were 0,0.3,0.5 and 0.7μg/(kg·h),respectively.The patients in control group were treated with equal volume of normal saline.The postoperative recovery and cognitive function in each group were recorded.Results The mean intraoperative sufentanil concentration and central artery pressure were significantly decreased in A0,A1,A2 and A3 groups at 30 min after the beginning of operation(P<0.05).The recovery time of spontaneous breathing and the time from calling to opening eyes in A2 group and A3 group were significantly prolonged(P<0.05).Compared with control group and A0 group,the MMSE scores of A1,A2 and A3 groups were higher on the first day after operation(P<0.05).Compared with control group and A0 group,the incidence of delirium was lower in A1,A2 and A3 groups after operation(P<0.05).The incidence of adverse reactions such as respiratory depression,hypotension,hypertension and bradycardia was significantly lower in A1 and A2 groups at 14 d after operation(P<0.05).Conclusion Taking 1.0μg/kg as the loading dose of dexmedetomidine and infusing sufentanil anesthesia at the rate of 0.3μg/(kg·h)can reduce the incidence of delirium after hip replacement in the elderly patients and reduce the incidence of adverse reactions on the basis of promoting the recovery of patients.

关 键 词：右美托咪定 老年人 髋关节置换术 谵妄 

分 类 号：R614[医药卫生—麻醉学]