右美托咪定对老年患者乳腺癌根治术后谵妄的影响  

Effects of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Radical Mastectomy

作　　者：胡文军[1] 马建新[2] 张弦 李倩[1] 王鑫磊 王景华[1] 张旭辉[1] HU Wenjun;MA Jianxin;ZHANG Xian;LI Qian;WANG Xinlei;WANG Jinghua;ZHANG Xuhui(Dept.of Anesthesiology,305 Hospital of PLA,Beijing 100017,China;Dept.of Health Care,305 Hospital of PLA,Beijing 100017,China;Dept.of Pharmacy,305 Hospital of PLA,Beijing 100017,China)

机构地区：[1]中国人民解放军第305医院麻醉科,北京100017 [2]中国人民解放军第305医院干部病房,北京100017 [3]中国人民解放军第305医院药局,北京100017

出　　处：《中国医院用药评价与分析》2021年第2期165-167,170,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：军队保健专项资助(No.18BJZ44)。

摘　　要：目的:探讨围术期使用右美托咪定对老年患者乳腺癌根治术后谵妄的影响。方法:选取2018年9月至2020年3月拟在全身麻醉下行乳腺癌手术的老年女性患者120例,采用随机数余数分组法将患者分为对照组和右美托咪定组,每组60例。右美托咪定组患者在麻醉诱导前15 min静脉泵注右美托咪定,负荷剂量为0.5μg/kg,然后以0.4μg/(kg·h)的速率静脉泵注至手术结束前30 min;对照组患者则以相同速率和相同容量静脉泵注0.9%氯化钠注射液。术后两组患者均使用含有舒芬太尼的静脉自控镇痛泵(patient-controlled intravenous analgesia,PCIA),右美托咪定组患者PCIA使用了舒芬太尼+右美托咪定,而对照组患者仅使用舒芬太尼。记录两组患者术后2 h、4 h、6 h、1 d、2 d及3 d的睡眠评分、活动和静息时视觉模拟评分(visual analogue scale,VAS)评分,谵妄的发生情况及持续时间。结果:术后6 h、1 d、2 d及3 d,右美托咪定组患者的静息和活动时VAS评分、睡眠评分明显低于对照组,差异均有统计学意义(P<0.05)。右美托咪定组患者的谵妄发生率为10%(6/60),平均持续时间为(0.8±0.3)d;对照组患者的谵妄发生率为30%(18/60),平均持续时间为(2.5±0.6)d;右美托咪定组患者的谵妄发生率较对照组明显降低,持续时间明显缩短,差异均有统计学意义(P<0.05)。与对照组相比,右美托咪定组患者术后低氧血症、心动过缓及低血压等不良反应发生率的差异均无统计学意义(P>0.05)。结论:围术期使用右美托咪定可以降低患者术后谵妄发生率,减轻谵妄的严重程度。OBJECTIVE:To explore the effects of dexmedetomidine on postoperative delirium in elderly patients undergoing radical mastectomy.METHODS:Totally 120 elderly female patients undergoing radical mastectomy with general anesthesia from Sept.2018 to Mar.2020 were extracted to be divided into the control group and the dexmedetomidine group via the random number table,with 60 cases in each group.Patients in the dexmedetomidine group received intravenous pumping of dexmedetomidine 15 min before induction of anesthesia,with loading dose of0.5μg/kg,and then intravenous pumping at the rate of 0.4μg/(kg·h)was given until 30 min before the end of the surgery.In the control group,0.9%sodium chloride injection was injected intravenously at the same rate and volume.After surgery,both groups received patient-controlled intravenous analgesia(PCIA)pump with sufentanil.The dexmedetomidine group was given sufentanil+dexmedetomidine for PCIA,while the control group only received sufentanil.Sleep scores,activity and resting visual analogue scale(VAS)scores,occurrence and duration of delirium were recorded after surgery of 2 h,4 h,6 h,1 d,2 d and 3 d in both groups.RESULTS:After surgery of 6 h,1 d,2 d and 3 d,VAS score and sleep score at resting and active time in the dexmedetomidine group were significantly lower than those in the control group,with statistically significant difference(P<0.05).The incidence of delirium in the dexmedetomidine group was 10%(6/60)and the average duration was(0.8±0.3)d;the incidence of delirium in the control group was 30%(18/60)and the average duration was(2.5±0.6)d;compared with the control group,the incidence of delirium in the dexmedetomidine group was significantly lower,and the duration was significantly shorter,the differences were statistically significant(P<0.05).Compared with the control group,there was no statistical significance in the incidence of postoperative hypoxemia,bradycardia,hypotension and other adverse reactions in the dexmedetomidine group(P>0.05).CONCLUSIONS:Dexmedetomidine adm

关 键 词：右美托咪定 老年 乳腺癌根治术 谵妄 

分 类 号：R971[医药卫生—药品]