地塞米松对骨关节置换术老年患者术后谵妄及认知功能障碍的影响

摘要

Objective To study the effect of Dexamethasone on postoperative delirium and cognitive dysfunction in elderly patients with joint replacement surgery.Methods Two hundred and twenty-five elderly patients with joint replacement surgery [≥65 years old,American Society of Anesthesiologists (ASA) Ⅱ-Ⅲ grade] in the First Affiliated Hospital of Chengdu Medical College from September 2015 to December 2016 were selected.These patients were divided into low dose of Dexamethasone group (group D1),high dose of Dexamethasone group (group D2) and control group (group C) by random number table,with 75 cases in each group.One hour before operation,group D1 was given intravenous injection of Dexamethasone 10 mg,group D2 was given intravenous injection of Dexamethasone 20 mg,group C was given intravenous injection of equal quantity of normal saline.The confusion assessment method-Chinese revision (CAM-CR),minimental state examination (MMSE) and visual analogue scale (VAS) were used to evaluate postoperative delirium,postoperative cognitive dysfunction and postoperative pain of the patients respectively.Results After operation for 1,3,7 days,the scores of CAM-CR in group D1 and D2 were all lower than those of group C,and the scores of MMSE were all higher than those of group C,with statistically significant differences (all P ＜ 0.01),while there were no significant differences of VAS scores compared with those of group C (P ＞ 0.05).There were no significant differences of the scores of CAM-CR,MMSE and VAS after operation for 1,3,7 days between group D1 and D2 (all P ＞ 0.05).After operation for 1,3,7 days,the incidence of postoperative delirium and cognitive dysfunction were all lower than those of group C,with statistically significant differences (all P ＜ 0.05),while there were no significant differences of the incidence of postoperative delirium and cognitive dysfunction after operation for 1,3,7 days between group D1 and D2 (P ＞ 0.05).Conclusion Application of Dexamethasone before operation can reduce the incidence of postoperative delirium and postoperative cognitive dysfunction in elderly patients underwent joint replacement surgery.%目的 研究地塞米松对骨关节置换术老年患者术后谵妄及认知功能障碍的影响.方法 选择2015年9月～2016年12月在成都医学院第一附属医院择期行骨关节置换手术的老年患者225例[年龄≥65岁,美国麻醉医师协会(ASA)Ⅱ～Ⅲ级],采用随机数字表法将其分为低剂量地塞米松组(D1组)、高剂量地塞米松组(D2组)和对照组(C组),每组各75例.术前1h,D1组静脉注射地塞米松10 mg,D2组静脉注射地塞米松20 mg,C组静脉注射等量生理盐水.分别采用意识错乱评估方法(CAM-CR)、简易精神状态量表(MMSE)和视觉模拟评分法(VAS)评估患者术后谵妄、术后认知功能障碍及术后疼痛情况.结果 D1、D2组患者术后1、3、7 d CAM-CR评分低于C组,MMSE评分高于C组,差异均有高度统计学意义(均P＜ 0.01),VAS评分与C组比较差异无统计学意义(P＞0.05).D1、D2组患者术后1、3、7 d CAM-CR、MMSE及VAS评分比较,差异均无统计学意义(均P＞0.05).D1、D2组患者术后1、3、7d谵妄及认知功能障碍发生率均低于C组(P＜0.05).D1、D2组患者术后1、3、7d谵妄及认知功能障碍发生率比较,差异均无统计学意义(P＞0.05).结论 术前应用地塞米松可降低骨关节置换术老年患者术后谵妄及术后认知功能障碍的发生率.