右美托咪定对老年骨质疏松合并股骨颈骨折患者全髋关节置换术后早期认知功能和苏醒的影响  

Effect of dexmedetomidine on early postoperative cognitive function and recovery after total hip replacement in elderly patients with osteoporosis complicated with femoral neck fracture

作　　者：杜娟[1] 李军[1] 何玲[1] 黄雪梅[1] 卢琴[1] 孙宝侠 冯海霞[1] 张永洪[1] Du Juan;Li Jun;Huang Xuemei;Lu Qin;Sun Baoxia;Feng Haixia;Zhang Yonghong(Department of Anesthesiology,Mianyang Central Hospital,Sichuan,Mianyang 621000,China)

机构地区：[1]绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《中国医学前沿杂志（电子版）》2020年第7期67-70,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：四川省卫生计生委科研课题(18PJ272)。

摘　　要：目的探讨右美托咪定对老年骨质疏松合并股骨颈骨折患者全髋关节置换术后早期认知功能和苏醒的影响。方法选取2018年12月至2019年12月绵阳市中心医院收治的214例老年骨质疏松合并股骨颈骨折患者为研究对象,均择期行全身麻醉下全髋关节置换术,按照随机数字表法将其分为观察组和对照组,每组各107例。观察组患者于麻醉诱导前经静脉输液泵注射0.5μg/kg右美托咪定,对照组患者于麻醉诱导前经静脉输液泵注射等剂量生理盐水。比较两组患者术中情况、芬太尼和丙泊酚用量、苏醒时间、不良反应发生情况及术前、术后1 d和术后3 d简易精神状态检查(mini-mental state examination,MMSE)评分。结果两组患者麻醉时间、手术时间、术中出血量、术后24 h不良反应发生率比较差异均无统计学意义(均P>0.05)。观察组患者芬太尼和丙泊酚用量均显著少于对照组(均P<0.05),呼吸恢复时间、睁眼时间和拔管时间均显著早于对照组(均P<0.05)。术后1 d和3 d,两组患者MMSE评分均显著低于本组术前(均P<0.05),观察组患者术后1 d和3 d MMSE评分均显著高于同期对照组(均P<0.05)。结论右美托咪定对老年骨质疏松合并股骨颈骨折患者全髋关节置换术后认知功能影响小,且可有效缩短术后苏醒时间。Objective To investigate the effect of dexmedetomidine on early postoperative cognitive dysfunction and recovery after total replacement in elderly patients with osteoporosis complicated with femoral neck fracture.Method From December 2018 to December 2019,214 elderly patients with osteoporosis complicated with femoral neck fracture in Mianyang Central Hospital were randomly divided into observation group and control group,with 107 cases in each group.Patients in observation group were injected with 0.5μg/kg dexmedetomidine by intravenous infusion pump before anesthesia induction,and patients in control group were injected with saline of equal dose by intravenous infusion pump before anesthesia induction.The intraoperative condition,dosage of fentanyl and propofol,recovery time,adverse reactions,mini-mental state examination(MMSE)scores before operation,1 day and 3 days after operation were compared between the two groups.Result There were no significant differences in anesthesia time,operation time,intraoperative blood loss and incidence of adverse reactions 24 h after operation between the two groups(all P>0.05).The dosage of fentanyl and propofol in observation group were significantly lower than those in control group(all P<0.05),and the respiratory recovery time,eye opening time and extubation time were significantly earlier than those in control group(all P<0.05).The MMSE scores at 1 day and 3 days after operation in the two groups were significantly lower than those before operation(all P<0.05),while the MMSE scores in observation group were significantly higher than those in control group at the same time(all P<0.05).Conclusion Dexmedetomidine has little effect on the cognitive function after total hip replacement in elderly patients with osteoporosis complicated with femoral neck fracture,and can effectively shorten the recovery time.

关 键 词：右美托咪定 全髋关节置换术 骨质疏松 股骨颈骨折 认知功能 苏醒 

分 类 号：R614[医药卫生—麻醉学]