右美托咪定预处理对老年患者谵妄评分的影响  

Effect of dexmedetomidine pretreatment on delirium score in elderly patients

作　　者：付益计[1] 杜立宏[1] 矫淑媛 FU Yiji;DU Lihong;JIAO Shuyuan(Anesthesia Operation Center,Anshan Central Hospital in Liaoning Province,Anshan114000,China;Department of Clinical Laboratory,Anshan Central Hospital in Liaoning Province,Anshan114000,China)

机构地区：[1]辽宁省鞍山市中心医院麻醉手术中心,辽宁鞍山114000 [2]辽宁省鞍山市中心医院检验科,辽宁鞍山114000

出　　处：《中国现代医生》2022年第9期127-130,共4页China Modern Doctor

摘　　要：目的探讨右美托咪定预处理对老年髋关节置换术患者脑损伤标记物(S100β﹑NSE)﹑炎症指标(IL-1β﹑CRP﹑PCT)和术后谵妄评分的影响。方法选取2019年2月至2020年11月在辽宁省鞍山市中心医院行髋关节置换术老年患者150例,随机分为3组:右美托咪定预处理+术中右美托咪定泵注组(DD组),等量溶剂预处理+术中右美托咪定泵注组(SD组),和全程溶剂组(S组)。DD组患者术前1天即泵入右美托咪定0.1μg(kg·h)持续24 h,入手术室后再给负荷量0.8μg/kg,随后以0.3μg/(kg·min)维持,直至手术结束;SD组患者术前1 d泵入等量生理盐水24 h,入手术室后处理同DD组;S组患者全程只泵入生理盐水。使用CAM-CR谵妄评分表测试患者手术前2 d和术后第1天的谵妄评分,检测患者入手术室即刻和术后第1天的血清S100β蛋白﹑NSE﹑IL-1β﹑CRP﹑PCT含量。结果三组患者术前2 d的谵妄评分和入手术室即刻的血清S100β﹑NSE﹑IL-1β﹑CRP﹑PCT含量差异无统计学意义(P>0.05),而术后第1天血清S100β﹑NSE﹑IL-1β﹑CRP和PCT含量以及谵妄评分比较,差异有统计学意义(P<0.05)。与S组比较,SD组患者血清的S100β﹑NSE﹑IL-1β﹑CRP和PCT含量降低,谵妄评分降低;与SD组比较,DD组患者血清的S100β﹑NSE﹑IL-1β﹑CRP和PCT含量降低,谵妄评分降低(P<0.05)。结论术前右美托咪定预处理可以进一步减轻老年髋关节置换患者术后脑损伤和炎症反应,并降低术后谵妄。Objective To explore the effect of dexmedetomidine pretreatment on brain injury markers(S100β,NSE),inflammatory indicators(IL-1β,CRP and PCT)and postoperative delirium score of elderly patients undergoing hip replacement.Methods A total of 150 elderly patients who underwent hip replacement in our hospital from February 2019 to November 2020 were selected.They were randomly divided into three groups:dexmedetomidine pretreatment+intraoperative dexmedetomidine pump injection group(DD group),equal solvent pretreatment+intraoperative dexmedetomidine pump injection group(SD group),and total solvent group(S group).Patients in DD group were given dexmedetomidine at dose of 0.1μg/(kg·h)one day before operation for 24 hours,and then given a load of 0.8μg/kg after entering the operating room,and then maintained at 0.3μg/(kg·h)until the end of operation.Patients in SD group were pumped with the same amount of normal saline for 24 hours one day before operation,and their post-treatment was the same as that in DD group.Patients in group S were only pumped with normal saline.The CAM-CR Delirium Severity Scale was used to test the delirium scores of the patients 2 days before operation and one day after operation,and the contents of S100βprotein,NSE,IL-1β,CRP and PCT in serum immediately after entering the operating room and one day after operation were detected.Results There were no significant differences in the delirium scores of the three groups 2 days before operation and the contents of serum S100β,NSE,IL-1β,CRP and PCT immediately after entering the operating room(P>0.05),but there were significant differences in the contents of serum S100β,NSE,IL-1β,CRP and PCT and delirium scores on the first day after operation(P<0.05).Compared with S group,the contents of S100β,NSE,IL-1β,CRP and PCT in serum and the delirium score were decreased in SD group.Compared with SD group,the contents of S100β,NSE,IL-1β,CRP and PCT in serum of DD group decreased,and the delirium score decreased as well(P<0.05).Conclusion Preop

关 键 词：右美托咪定预处理 术后谵妄 神经特异性蛋白100β 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]