老年患者应用右美托咪定联合椎管内麻醉的镇静效果及影响患者术后认知功能障碍的危险因素分析  

Sedative Effect of Dexmedetomidine Combined with Spinal Anesthesia and Risk Factors for Postoperative Cognitive Dysfunction in Older Patients

作　　者：史炯[1] 何平[1] 赵翠党 赵广平[1] 刘亚男[1] 陈永学[1] Shi Jiong;He Ping;Zhao Cuidang;Zhao Guangping;Liu Yanan;Chen Yongxue(Department of Anesthesiology,Handan Central Hospital,Handan 056000)

机构地区：[1]河北省邯郸市中心医院麻醉科,邯郸056000

出　　处：《国际老年医学杂志》2021年第3期158-162,共5页International Journal of Geriatrics

基　　金：2019年度河北省医学科学研究课题计划(20191850)。

摘　　要：目的分析老年患者应用右美托咪定(Dex)联合椎管内麻醉的镇静效果及影响患者术后认知功能障碍(POCD)的危险因素。方法选择邯郸市中心医院2016年8月~2018年8月椎管内麻醉患者132例,分为对照组和Dex组,各66例。根据患者术后是否发生POCD,分为POCD组和非POCD组。各组患者均行椎管内麻醉,Dex组静脉泵入Dex辅助镇静,对照组静脉泵入生理盐水。通过Ramsay镇静评分比较分析不同时间段对照组和Dex组的麻醉镇静效果,并统计两组术中血管活性药物的使用情况。此外设计老年患者应用椎管内麻醉POCD危险因素调查表,通过多因素logistic回归分析影响POCD发生的相关危险因素。结果两组手术时间、应用血管活性药物方面比较,差异无统计学意义(P>0.05),Dex组泵注Dex后各时间Ramsay评分均较泵入前显著升高(P<0.05),泵入10 min后患者显著镇静;Dex组术后1周内POCD累计发生6例(9.1%),对照组24例(36.4%),差异有统计学意义(P<0.05)。本次试验共选择了14个可能与术后POCD有统计学关联因素进行χ^(2)检验,初步筛选出6个(ASA分级、糖尿病、认知水平、术后第1d VAS评分、术中Dex使用、手术时间)与术后POCD有关的危险因素;多因素logistic回归分析显示ASA分级、术后第1d VAS评分、认知水平、术中Dex使用为POCD危险因素。结论老年患者椎管内麻醉时Dex静脉泵注可以产生适度镇静,降低POCD发生。影响椎管内麻醉老年患者POCD的危险因素较多,需受到人们的重视。Objective To analyze the sedative effect of dexmedetomidine combined with spinal anesthesia in older patients and the risk factors for postoperative cognitive dysfunction(POCD).Methods A total of 132 patients with spinal anesthesia in Handan Central Hospital were selected from August 2016 to August 2018.The patients were divided into control group and dexmedetomidine(Dex)group by random number table,with 66 cases in each group.In addition,the patients were also divided into POCD group and POCD-free group according to the occurrence of POCD after surgery.All patients were given spinal anesthesia.The patients in Dex group were additionally given intravenous infusion of Dex,and control group was given intravenous infusion of saline.Ramsay sedation scale was used to evaluate the anesthetic sedation effect.The intraoperative use of vasoactive agents was documented.Multivariate logistic regression was used to analyze the risk factors for POCD.Results There were no significant differences between the control group and Dex group in the operation time and the dosage of vasoactive drugs(P>0.05).Ramsay score was significantly increased at different time points after dexmedetomidine infusion in the Dex group compared with that before infusion(P<0.05),and the sedation effect was apparent after 10 min of infusion.The incidence of POCD(6 cases,9.1%)in Dex group was lower than that in control group(24 cases,36.4%)within 1 week after surgery(P<0.05).Multivariate logistic regression analysis showed that ASA classification,VAS score at day 1 after surgery,cognitive level and intraoperative Dex use were the risk factor for POCD.Conclusion Dex intravenous infusion during spinal anesthesia in older patients could produce moderate sedation and reduce the incidence of POCD.There are many risk factors for POCD in older patients with spinal anesthesia,which need to be paid more attention.

关 键 词：老年 右美托咪定 椎管内麻醉 镇静 认知功能障碍 危险因素 

分 类 号：R614[医药卫生—麻醉学]