应用小剂量右美托咪定预防老年髋骨折患者术后谵妄的前瞻性随机对照研究  

Low dose dexmedetomidine for prevention of delirium in elderly patients after hip fractured surgery:a randomized controlled trial

作　　者：崔真[1] 佟梦琦[1] 王君 白颖[1] Cui Zhen;Tong Mengqi;Wang Jun;Bai Ying(Department of Intensive Care Medicine, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing 100035, China)

机构地区：[1]北京大学第四临床医学院北京积水潭医院重症医学科,100035

出　　处：《骨科临床与研究杂志》2021年第3期165-169,共5页Journal Of Clinical Orthopedics And Research

基　　金：北京积水潭医院院级科研基金青年(QN-201919)。

摘　　要：目的探讨应用小剂量右美托咪定预防老年髋骨折患者术后谵妄的有效性与安全性。方法采用前瞻性随机对照研究方法。纳入2019年7月至2020年9月北京大学第四临床医学院北京积水潭医院重症医学科(ICU)收治的老年髋骨折术后患者127例,中位年龄86(83,89)岁。患者接受手术方式包括全髋关节置换术19例(15.0%),半髋关节置换术29例(22.8%),髓内针内固定术79例(62.2%)。以随机数字表法将患者分为右美托咪定组(简称右美组,65例)与安慰剂组(62例)。在患者进入ICU后2 h内对右美组患者给予盐酸右美托咪定0.1μg/(kg·h)静脉泵入,对安慰剂组给予生理盐水0.025 ml/(kg·h)静脉泵入。观察2组患者的谵妄、低血压、心动过缓、低氧血症、术后并发症的发生率以及ICU住院时间、住院病死率等指标并进行组间比较。采用SPSS软件对数据进行统计学分析。结果右美组患者谵妄发生率低于安慰剂组(4.8%比15.3%,P=0.019)。右美组患者入ICU后8 h和14 h动脉压低于安慰剂组(P=0.035,0.046);右美组患者入ICU后8 h心率低于安慰剂组(P=0.016)。与安慰剂组相比,右美组患者低血压和心动过缓发生率没有明显增加(均P>0.05)。在使用镇痛泵的同时,依据需要右美组2例患者追加使用阿片类药镇痛,安慰剂组14例患者追加使用阿片类药镇痛,两组差异有统计学意义(P=0.01)。结论应用低剂量右美托咪定可显著降低ICU老年髋部骨折患者术后谵妄发生率,同时减少患者阿片类镇痛药的使用,且有较好的安全性。Objective To investigate the efficacy and safety of low-dose dexmedetomidine in the prevention of postoperative delirium in elderly patients with hip fracture.Methods A total of 127 elderly postoperative patients with hip fractures admitted to the Department of Intensive Care Medicine(ICU),Beijing Jishuitan Hospital,the Fourth Clinical Medical College of Peking University from July 2019 to September 2020 were included.The median age was 86(83,89)years.Total hip arthroplasty,hemiarthroplasty and intramedullary nail fixation were performed in 19 cases(15.0%),29 cases(22.8%)and 79 cases(62.2%),respectively.The patients were randomly divided into dexmedetomidine group(65 cases)and placebo group(62 cases).Dexmedetomidine hydrochloride 0.1μg/(kg·h)was given intravenously to the dexmedetomidine hydrochloride group,and 0.025 ml/(kg·h)normal saline was given to the placebo group in 2 h after the patient entered the ICU.The incidence of delirium,hypotension,bradycardia,hypoxemia,postoperative complications,length of ICU stay and mortality were observed and compared between the 2 groups.Results The incidence of delirium in dexamedetomidine group was lower than that in placebo group(4.8%vs 15.3%,P=0.019).The arterial pressure of dexamedetomidine group was lower than that of placebo group at 8 h and 14 h after ICU admission,and the heart rate of dexamedetomidine group was lower than that of placebo group at 8 h after ICU admission(P=0.035,0.046,0.016).Compared with the placebo group,the incidence of hypotension and bradycardia were not significantly increased in the dexamedetomidine group(all P>0.05).At the same time of using analgesia pump,2 patients in dexamedetomidine group were given additional opioid analgesia,and 14 patients in placebo group were given additional opioid analgesia.The difference between the 2 groups was statistically significant(P=0.01).Conclusion Prophylactic use of low-dose dexmedetomidine can decrease the incidence of postoperative delirium in elderly patients with hip fracture in ICU and reduce th

关 键 词：谵妄 化学预防 髋骨折 手术后医护 重症监护 右美托咪啶 老年人 

分 类 号：R47[医药卫生—护理学]