右美托咪定和瑞芬太尼对老年髋部骨折手术患者术后谵妄的效果比较

摘要

目的:比较右美托咪定和瑞芬太尼治疗老年髋部骨折术后患者谵妄的治疗效果.方法:选择2014年6月—2015年5月赣州市立医院收治的120例老年髋部骨折手术患者作为研究对象,采用随机数字表法分为A组和B组各60例.A组患者静脉注射右美托咪定0.3~0.8μg/( kg· h),B组患者静脉注射瑞芬太尼1 000~2 500 μg/h,采用意识障碍评估法评测2组患者谵妄的发生率.结果:A组患者的谵妄发生率为13.33%(8/60),B组患者的谵妄发生率为31.67%(19/60),2组的差异有统计学意义(P<0.05).2组患者术后发生的不良反应主要为窦性心动过缓、低血压及呼吸困难导致的再次气管内插管,A组患者窦性心律过缓的发生率为23.33%(14/60),低血压发生率为25.00%(15/60),呼吸困难导致的再次气管插管发生率为3.33%(2/60),B组为30.00%(18/60)、40.00%(24/60)、20.00%(12/60),2组的差异有统计学意义(P<0.05).结论:老年髋部骨折手术患者应用静脉注射右美托咪定可降低谵妄发生率,降低窦性心动过缓、低血压以及呼吸困难导致的再次气管内插管等不良反应的发生率,值得临床推广.%OBJECTIVE:To compared the treatment effects of dexmedetomidine and remifentanil on delirium after hip fracture surgery in elderly patients.METHODS:120 cases of elderly patients with hip fracture surgery and admitted into Ganzhou Municipal Hospital fron Jun.2014 to May 2015 were selected to be divided into group A and group B via the random number table,with 60 cases in each group.Group A were treated with intravenous 0.3-0.8 μg/( kg· h ) dexmedetomidine,while group B received intravenous 1 000-2 500 μg/h remifentanil,the disturbance of consciousness assessment evaluation method was adopted to determine the incidence of delirium in two groups of patients.RESULTS:The incidence of delirium in group A was 13.33%(8/60),and in group B was 31.67%(19/60),the difference was statistically significant(P<0.05).The postoperative adverse reactions were mainly be seen in sinus bradycardia(SB),hypotension and the endotracheal intubation caused by dyspnea.The incidence of SB,hypotension and the endotracheal intubation caused by dyspnea in group A were respectively 23.33%(14/60),25.00%(15/60)and 3.33%(2/60),and in group B were respectively 30.00%(18/60),40.00%(24/60) and 20.00%(12/60),with statistical significance ( P<0.05).CONCLUSIONS:Dexmedetomidine and remifentanil in treatment of delirium after hip fracture surgery in elderly patients can reduce the incidence of delirium,the incidence of SB,hypotension and the endotracheal intubation caused by dyspnea and some other adverse reactions,it is worthy of clinical promotion.