右美托咪定复合不同麻醉深度对老年全髋关节置换术患者术后谵妄的影响  

Effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients undergoing total hip replacement

作　　者：徐孟婷 凌云志[2] 张景俊[3] 徐晖[3] XU Meng-ting;LING Yun-zhi;ZHANG Jing-jun;XU Hui(Graduated School of Bengbu Medical College,Bengbu,Anhui 233000,China;不详)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]蚌埠医学院第一附属医院麻醉科,安徽蚌埠233004 [3]蚌埠市第三人民医院麻醉科,安徽蚌埠233000

出　　处：《中华全科医学》2021年第10期1646-1649,共4页Chinese Journal of General Practice

基　　金：安徽省高等学校自然科学研究重点项目(KJ2019A0330);蚌埠医学院自然科学基金项目(BYKY18181)。

摘　　要：目的探讨分析右美托咪定复合不同麻醉深度对行全髋关节置换术的老年患者术后意识障碍及谵妄发生率的影响。方法选取2018年12月-2020年5月于蚌埠医学院第一附属医院就诊,并行全髋关节置换术的96例老年患者为研究对象,根据其脑电双频指数(BIS)不同分为3组,A组BIS值为40~49(32例),B组BIS值为50~59(35例),C组BIS值为60~69(29例),观察比较3组患者术后意识障碍程度、血清神经元特异性烯醇化酶(NSE)和S100β蛋白浓度及谵妄发生情况。结果术后意识障碍程度对比,术后72 h简易精神状态评价量表(MMSE)评分组间比较差异有统计学意义(P<0.05),B组术后72 h MMSE评分高于A组、C组(均P<0.05),A组与C组比较差异无统计学意义(P>0.05);术后72 h NSE和血清S100β蛋白浓度组间比较差异有统计学意义(均P<0.05),B组术后72 h NSE和血清S100β蛋白浓度低于A、C组(均P<0.05),A组与C组NSE和血清S100β蛋白浓度差异无统计学意义(均P>0.05);3组患者术后72 h内发生谵妄分别有8例(25.00%)、1例(2.86%)、7例(24.14%),组间比较差异有统计学意义(P<0.05),B组术后谵妄发生率低于A组、C组(均P<0.017),A组与C组术后谵妄发生率比较差异无统计学意义(P>0.017)。结论对进行全髋关节置换术的老年患者予以右美托咪定复合麻醉深度控制在50~59范围最佳,不仅可有效改善其NSE和血清S100β蛋白浓度,还可降低术后意识障碍程度以及谵妄的发生率。Objective To investigate the effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients with total hip replacement. Methods A total of 96 elderly patients undergoing total hip arthroplasty in our hospital from December 2018 to May 2020 were selected and divided into three groups according to their bispectral index(BIS). The BIS values of groups A, B and C were 40-49(n=32), 50-59(n=35) and 60-69(n=29), respectively. The degree of consciousness disturbance, serum neuron-specific enolase(NSE), serum S100β protein concentration and delirium were observed and compared amongst the three groups. Results The Mini-Mental State Examination(MMSE) scores of the three groups were significantly different(P<0.05). The MMSE score of group B was higher than that of groups A and C(all P<0.05), but no significant difference was observed between group A and group C(P>0.05). Compared with NSE and serum S100β protein concentration before operation, NSE and serum S100β protein concentration at 72 h after operation were significantly different amongst the three groups(all P<0.05). NSE and serum S100β protein concentrations in group B were lower than those in groups A and C(all P<0.05), but no difference was observed between group A and group C in terms of NSE and serum S100 β protein concentration(all P>0.05). Eight cases(25.00%), 1 case(2.86%) and 7 cases(24.14%) of delirium were observed in groups A, B and C within 72 h after operation, respectively. A significant difference was observed between the three groups(P<0.05). The incidence of postoperative delirium in group B was lower than that in groups A and C(all P<0.017), but no difference was observed between group A and group C(P>0.017). Conclusion Dexmedetomidine combined with anaesthesia depth range of 50-59 can not only effectively improve the NSE and serum S100β protein concentration, but also reduce the degree of postoperative consciousness disturbance and delirium in elderly patients undergoing total hip replacement.

关 键 词：全髋关节置换术 右美托咪定 复合不同麻醉深度 术后谵妄 影响 

分 类 号：R614.24[医药卫生—麻醉学] R687.4[医药卫生—外科学]