小剂量右美托咪定对老年髋部骨折术后血流动力学的影响  

Effect of Low-Dose Dexmedetomidine on Postoperative Hemodynamics in Elderly Hhip Fractures

作　　者：崔真[1] 佟梦琦[1] 于淼淼 白颖[1] Cui Zhen;Tong Mengqi;Yu Miaomiao;Bai Ying(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院重症医学科,北京100035

出　　处：《实用骨科杂志》2022年第2期126-130,共5页Journal of Practical Orthopaedics

基　　金：北京积水潭医院学科新星人才培养计划(XKXX202108)。

摘　　要：目的观察小剂量右美托咪定对于老年髋部骨折术后患者血流动力学的影响。方法前瞻性研究2020年7月至2021年8月北京积水潭医院重症医学科(intensive care unit,ICU)收治的老年髋部骨折术后患者114例,其中男52例,女62例;年龄74~97岁,平均(87.5±6.8)岁。手术方式:全髋关节置换术14例,半髋关节置换术24例,髓内针内固定术76例。114例随机分为右美组和对照组。右美组入ICU后给予盐酸右美托咪定每小时0.1μg/kg静脉泵入,对照组给予0.9%盐水每小时0.025 mL/kg静脉泵入。观察至次日8点并停药。右美组56例,男25例,女31例;年龄74~96岁,平均(83.2±5.2)岁。对照组58例,男27例,女31例;年龄76~97岁,平均(84.4±6.8)岁。使用无创心排量监测仪(non-invasive cardiac output monitoring,NICOM)进行血流动力学监测,观察两组血流动力学参数的变化(心指数、每搏量指数、平均动脉压、动脉收缩压、动脉舒张压、心率、血乳酸)以及谵妄发生率、ICU住院时间、住院死亡率、术后并发症等指标。结果两组血流动力学监测结果(术后心指数、每搏量指数、平均动脉压、动脉收缩压、动脉舒张压、心率、血乳酸比较)差异均无统计学意义(P>0.05)。两组低血压和心动过缓发生率比较差异无统计学意义(P>0.05)。右美组谵妄发生率明显低于对照组(P=0.048),右美组高血压发生率明显低于对照组(P=0.006)。两组在ICU住院时间及术后并发症方面比较,差异无统计学意义(P>0.05)。结论老年髋部骨折术后患者持续小剂量右美托咪定泵入,可以有效降低谵妄及术后高血压的发生率,且没有对血流动力学参数产生显著影响。Objective To observe the effect of low-dose dexmedetomidine on hemodynamics in elderly patients with hip fracture.Methods Elderly patients with hip fracture treated in the intensive care unit(ICU)of Beijing Jishuitan Hospital from July 2020 to August 2021 were enrolled.The age ranged from 74 to 97 years,with an average of(87.5±6.8)years.The operative methods included total hip arthroplasty in 14 cases,hemiarthroplasty in 24 cases and intramedullary nail fixation in 76 cases.114 patients were randomly divided into dexmedetomidine group and control group.After entering ICU,the dexmedetomidine group was given dexmedetomidine 0.1μg/kg per hour,and the control group was given 0.9%saline 0.025 mL/kg per hour.The patients were observed until 8 o'clock of the next day and drug administration stopped the.There were 56 cases in dexmedetomidine group,including 25 males and 31 females.The age ranged from 74 to 96 years,with an average of(83.2±5.2)years.There were 58 cases in the control group,including 27 males and 31 females.The average age was(84.4±6.8)years.Non invasive cardiac output monitoring(nicom)was used for hemodynamic monitoring.The changes of hemodynamic parameters in the two groups(cardiac output index,stroke volume index,mean arterial pressure,systolic blood pressure,diastolic blood pressure,heart rate,lactic acid)and the incidence of delirium,length of stay in ICU,in-hospital mortality and postoperative complications were observed.Results There was no significant difference in postoperative cardiac index,stroke volume index,mean arterial pressure,arterial systolic pressure,arterial diastolic pressure,heart rate and lactic acid(P>0.05).There was no significant difference in the proportion of hypotension and bradycardia(P>0.05).The incidence of delirium in the dexmedetomidine group was significantly lower than that in the control group(P=0.048).The incidence of hypertension in dexmedetomidine group was significantly lower than that in the control group(P=0.006).There was no significant difference in average

关 键 词：高龄 髋部骨折 右美托咪定 血流动力学 谵妄 

分 类 号：R683.3[医药卫生—骨科学]