右美托咪定和丙泊酚不同术中镇静方式对老年髋关节置换术患者术后谵妄的影响  

Effects of Different Intraoperative Sedation Methods of Dexmedetomidine and Propofol on Postoperative Delirium in Elderly Patients Undergoing Hip Replacement

作　　者：代胜刚 徐进[1] 苗子强[1] DAI Shenggang;XU Jin;MIAO Ziqiang(Department of Anesthesiology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院麻醉二科,天津300211

出　　处：《中国药物滥用防治杂志》2024年第6期1000-1002,1011,共4页Chinese Journal of Drug Abuse Prevention and Treatment

基　　金：国家自然科学基金青年项目(编号:82102639)。

摘　　要：目的:探讨右美托咪定和丙泊酚不同术中镇静方式对老年髋关节置换术患者术后谵妄的影响。方法:纳入天津市天津医院2021年1月—2022年8月在腰硬联合麻醉下行老年髋部骨折择期髋关节置换术的患者118例,根据术中镇静药物不同分为右美托咪定组(D组,n=59)和丙泊酚组(P组,n=59),比较两组临床参数变化。结果:两组手术时间、麻醉时间、出血量、麻黄碱用量、去甲肾用量、阿托品用量比较,差异无统计学意义(P>0.05);D组术后谵妄发生率低于P组(P<0.05);两组镇静前MAP和HR无差异,而D组镇静30 min后MAP高于P组,在PACU时MAP低于P组,且D组镇静30 min后及在PACU时HR低于P组(P<0.05)。结论:针对腰硬联合麻醉下择期行髋关节置换术的老年患者,术中予右美托咪定的镇静效果优于丙泊酚镇静,其能降低术后谵妄发生率,且可稳定术中血流动力学变化。Objective:To explore the effect of different intraoperative sedation methods of dexmedetomidine and propofol on postoperative delirium in elderly patients undergoing hip replacement surgery.Methods:A total of 118 elderly patients who underwent elective hip replacement surgery for hip fractures under lumbar epidural anesthesia at Tianjin Hospital from January 2021 to August 2022 were included.They were divided into two groups based on different sedative drugs during surgery:the dexmedetomidine group(D group,n=59)and the propofol group(P group,n=59).The clinical parameters of the two groups were compared.Results:There was no significant difference in operation time,anesthesia time,bleeding volume,ephedrine dosage,norepinephrine dosage and atropine dosage between the two groups(P>0.05).The incidence of postoperative delirium in group D was lower than that in group P(P<0.05).There was no difference in MAP and HR between the two groups before sedation,while MAP in group D was higher than that in group P after 30 min of sedation,MAP in PACU was lower than that in group P,and HR in group D was lower than that in group P after 30 min of sedation and in PACU(P<0.05).Conclusion:For elderly patients undergoing elective hip replacement under combined spinal-epidural anesthesia,the sedative effect of intraoperative dexmedetomidine is better than that of propofol,which can reduce the incidence of postoperative delirium and stabilize intraoperative hemodynamic changes.

关 键 词：右美托咪定 丙泊酚 术后谵妄 老年髋部骨折 

分 类 号：R614[医药卫生—麻醉学]