摘要
目的评价右美托咪啶复合麻醉对高龄髋关节置换术患者术后谵妄的影响。方法择期行全髋关节置换术患者160例，性别不限，年龄75～85岁，BMI20-25kg／m2，ASA分级Ⅱ或Ⅲ级。采用随机数字表法，将患者随机分为2组（n：80）：七氟醚．芬太尼组（c组）和右美托咪啶．七氟醚-芬太尼组（D组）。D组麻醉诱导前经15min静脉输注右美托咪啶负荷量0．6μg／kg，随后以0．2μg·kg～·h“的速率静脉输注至术毕，C组给予等容量生理盐水。负荷量输注完毕后5min2组均静脉注射芬太尼2～4μg／kg、依托眯酯0．1—0．3mg／kg和顺阿曲库铵0．15mg／kg麻醉诱导，气管插管后行机械通气。麻醉维持：吸入七氟醚（呼气末靶浓度1％-3％），间断静脉注射芬太尼0．05mg，维持BIS值40～60。记录依托咪酯、芬太尼和七氟醚的用量、苏醒期躁动及术后24h内谵妄发生情况。结果与C组比较，D组依托咪酯、芬太尼和七氟醚的用量减少，苏醒期躁动发生率及术后24h内谵妄的发生率降低（P〈0．05）。结论右美托咪啶复合麻醉可降低高龄髋关节置换术患者术后谵妄的发生。
Objective To investigate the effect of dexmedetomidine combined anesthesia on postoperative delirium in the elderly patients undergoing hip joint replacement. Methods One hundred and sixty ASA 1] or m patients, aged 75-85 yr, with a body mass index of 20-25 kg/m2 , scheduled for elective total hip joint replacement under general anesthesia, were randomly divided into 2 groups （ n = 80 each） ： sevoflurane-fentanyl control group （group C） and dexmedetomidine-sevoflurane-fentanyl group （group D）. Dexmedetomidine was intravenously in- fused at O. 2μg kg h-1 until the end of operation after a loading dose of 0.6 μg/kg over 15 min before induction of anesthesia in group D, while the equal volume of normal Saline was infused in group C. Anesthesia was induced with iv injection of fentanyl 2-4μg/kg and etomidate 0.1-0.3 mg/kg at 5 min after the end of administration of the loading dose. Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg and the patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane （the end-tidal concentration 1%-3% ） and intermittent iv boluses of fentanyl 0.05 mg. BIS was maintained at 40-60 during operation. The consumption of etomidate, fentanyl, and sevoflurane, agitation during emergence from anesthesia, and postopera- tive delirium within 24 h after operation were recorded. Results Compared with group C, the consumption of eto- midate, fentanly, and sevoflurane was significantly reduced and the incidences of agitation during emergence from anesthesia and postoperative delirium within 24 h after operation were significantly decreased in group D （ P 〈 0.05）. Conclusion Dexmedetomidine combined anesthesia can reduce the occurrence of postoperative delirium in the elderly patients undergoing hip joint replacement.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第8期936-938,共3页
Chinese Journal of Anesthesiology
基金
云南省应用基础研究基金面上项目（2010ZC179）
关键词
右美托咪啶
麻醉
全身
老年人
谵妄
手术后并发症
Dexmedetomidine
Anesthesia, general
Aged
Delirium
Postoperative complication
