小剂量神经安定镇痛预防老年患者术后谵妄的随机对照研究  

A randomized controlled study of low-dose neuroleptanalgesia in the prevention of postoperative delirium in elderly patients

作　　者：宋翠侠[2] 张骁[1] 周小欣[1] 苏忠雪 黄莉莉[1] 黄贞玲[1] 苏殿三[1] SONG Cuixia;ZHANG Xiao;ZHOU Xiaoxin;SU Zhongxue;HUANG Lili;HUANG Zhenling;SU Diansan(Department of Anesthesiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]上海市第八人民医院麻醉科

出　　处：《上海医学》2022年第6期400-405,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(81970995)。

摘　　要：目的探讨小剂量神经安定镇痛对老年患者术后谵妄的预防作用。方法选取2020年2-6月于上海交通大学医学院附属仁济医院和上海市第八人民医院择期行全身麻醉(简称全麻)下非心脏手术且手术时间>2 h的老年患者170例,年龄范围为65~85岁,ASA分级为Ⅰ或Ⅱ级,采用随机数字表法分组,其中试验组84例,对照组86例。术中行常规麻醉监测管理,手术结束前30 min,对试验组患者给予小剂量神经安定镇痛,即缓慢静脉注射小剂量1.25 mg氟哌利多和0.025 mg枸橼酸芬太尼;对照组患者缓慢静脉注射同等容量的0.9%氯化钠溶液。比较两组患者术后7 d内的谵妄发生情况、麻醉后监测治疗室(PACU)停留时间、PACU躁动发生情况、术后恶心和呕吐的发生情况、住院时间、术中麻醉药物的使用情况等。结果与对照组相比,试验组患者术后谵妄发生率(对照组比试验组:29.1%比11.9%,P=0.008)、PACU躁动发生率(对照组比试验组:14.3%比38.4%,P<0.001)和术后恶心呕吐发生率(对照组比试验组:15.5%比40.7%,P<0.001)均显著降低,PACU停留时间[对照组比试验组:(75.41±4.84)min比(67.94±3.51)min,P=0.011]和住院时间[对照组比试验组:(13.86±2.48)d比(11.31±2.36)d,P=0.005]均显著缩短。结论使用小剂量神经安定镇痛药物可有效降低术后谵妄的发生率,减少术后躁动的发生,预防术后恶心及呕吐的发生,缩短术后PACU停留时间和住院时间。Objective To investigate the preventive effect of low-dose diazepam on postoperative delirium in elderlyⅠ-Ⅱpatients.Methods A total of 170 patients aged 65-85 years who were in ASA grade and underwent elective non cardiac surgery under general anesthesia(operation time>2 h)from February 2020 to June 2020 in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Eighth People’s Hospital were enrolled in this study.They were randomly divided into experimental group(n=84)and control group(n=86).Routine anesthesia monitoring and management were conducted during the operation.Thirty minutes before the end of the operation,the patients in the experimental group were given low-dose neuroleptanalgesia(slow intravenous injection of 1.25 mg droperidol and 0.025 mg fentanyl citrate),and the patients in the control group were given 0.9%sodium chloride of the same volume by intravenous injection.The following indexes were observed and compared between the two groups:delirium within 7 days after operation,time in anesthesia recovery room(PACU),irritability in PACU,postoperative nausea and vomiting,length of hospital stay,and the use of intraoperative anesthetic drugs.Results In comparison with the control group the experimental group had lower incidence of postoperative delirium(29.1%vs 11.9%,P=0.008),lower PACU irritability(14.3%vs 38.4%,P<0.001),lower incidence of postoperative nausea and vomiting(15.5%vs 40.7%,P<0.001),shorter PACU stay([75.41±4.84]min vs[67.94±3.51]min,P=0.011)and shorter hospital stay([13.86±2.48]d vs[11.31±2.36]d,P=0.005).Conclusion Low-dose neuroleptanalgesia can effectively reduce the incidence of postoperative delirium,irritation,nausea and vomiting,and shorten PACU stay and hospital stay.

关 键 词：术后谵妄 神经安定镇痛 氟哌利多 

分 类 号：R614[医药卫生—麻醉学]