右美托咪定对改善老年人工髋关节置换术患者认知功能及谵妄效果评价

摘要

Objective To study the effect of dexmedetomidine (DEX) on cognitive function and delirium in elderly patients after artificial hip replacement. Methods 60 elderly patients undergoing artificial hip replacement in our hospital were divided into the DEX group and the control group according to the different methods of anesthesia, 30 cases in each group, ECG,heart rate, MAP, SpO2,PaO2,of the two groups before and after operation were compared, MMSE was used to evaluate the intelligent status of the patients, Ramsay was used to assess the sedation of the two groups, the occurrence of delirium at 48h after operation was observed. Results The heart rate (HR), mean arterial pressure (MAP) and partial pressure of oxygen (PaO2) of the two groups showed an firstly increasing and then decreasing trend (P＜0.01), HR, MAP, PaO2 in the DEX group at T1-T3 were significantly lower than those in the control group(P＜0.05). MMSE scores of the two groups at 3d before operation were significantly lower than those at 1d before operation (P＜0.05),the decreasing amplitude of the DEX group was significantly less than that of the control group (P＜0.05),the two groups returned to normal at 7 d after operation. The incidence of post operative cognitive dysfunction in the DEX group was significantly lower than that in the control group (P＜0.05). The sedative effect in DEX group at T2, T4, T5 was significantly better than that in the control group (P＜0.01),and the incidence of delirium in DEX group was significantly lower than that in the control group (P＜0.05). Conclusion DEX has better sedative effect in elderly patients with artificial hip replacement, it has little effect on the haemodynamics and pulmonary gas exchange function, and the occurrence rates of postoperative cognitive dysfunction and delirium are lower.%目的 探讨右美托咪定对改善老年人工髋关节置换术患者认知功能及谵妄的效果评价.方法 将60例需行人工髋关节置换术的老年患者按手术麻醉方法不同分为右美托咪定组及对照组各30例,比较手术前后不同时点两组心电图、心率、平均动脉压、脉搏血氧饱和度和氧分压,采用简易智力状况检查法评定患者智力状况,采用Ramsay评定两组镇静状况,观察术后48h患者谵妄发生情况.结果 两组心率、平均动脉压及氧分压均呈先升高后降低的趋势(P＜0.01),右美托咪定组T1-T3时间点心率、平均动脉压及氧分压均显著低于对照组(P＜0.05).手术后3 d两组简易智力状况检查法评分均显著低于手术前1 d(P＜0.05),右美托咪定组降低幅度显著小于对照组(P＜0.05),手术后7 d两组均恢复正常.手术后48 h右美托咪定组认知功能障碍发生率显著低于对照组(P＜0.05).T2、T4、T5时间点右美托咪定组镇静效果均显著优于对照组(P＜0.01),谵妄发生率显著低于对照组(P＜0.05).结论 右美托咪定对老年人工髋关节置换术患者镇静效果良好,术中血流动力学水平及肺气体交换功能变化均较小,术后认知功能障碍及谵妄发生率较低.