摘要
目的探讨右美托咪定预防膝关节置换术后全身麻醉老年患者苏醒期躁动的效果.方法选取膝关节置换术70例老年患者,随机分为观察组和对照组各35例,对照组采用常规静脉全身麻醉,观察组在麻醉诱导开始时,患者静脉泵入0.05μg/kg、20mL右美托咪定溶液,在15min内完成.术后24h,使用Ricker镇静-躁动评分(SAS)、视觉模拟评分(VAS)评价两组患者的术后躁动情况及疼痛程度.对比两组患者给药前、拔管后的去甲肾上腺素(NE)水平.根据苏醒后4h观察组SAS水平中位数分为躁动组(SAS>中位数)和镇静组(SAS≤中位数).比较躁动组和镇静组拔管时NSE水平有无差异.同时,以拔管时NSE水平为参考,评价其预测右美托咪定预防术后躁动的敏感性和特异性及ROC曲线下面积.结果术后24h观察组SAS及VAS评分分别为(3.24±0.64)和(1.84±0.63),显著低于对照组的(4.60±0.59)和(3.03±0.41),差异有统计学意义(P<0.05);患者苏醒后观察组和对照组SAS评分均开始降低,但观察组降低更为明显(P<0.05);苏醒后观察组和对照组VAS评分呈现先升高再降低的趋势,且观察组各个时间点VAS评分均低于对照组(P<0.05).观察组患者拔管后的NE水平为(277.78±44.44),显著低于对照组的(482.85±76.77),差异有统计学意义(P<0.05).根据苏醒后4h观察组SAS水平中位数3.26(Range:1.972-4.54)分为躁动组(SAS>3.26,n=17)和镇静组(SAS≤3.26,n=18).躁动组和镇静组拔管时NSE水平分别为(297.8±47.8)ng/L和(258.9±31.9)ng/L,差异有统计学意义(P<0.05).以NSE为参考,预测苏醒后4h患者是否躁动敏感性和特异性分别为68.2%和66.7%,ROC曲线下面积为0.712(P<0.05).结论右美托咪定可缓解膝关节置换术后全身麻醉老年患者苏醒期躁动情况,拔管时NE水平可作为右美托咪定预防躁动的生物学标志物.
Objective To investigate the effect of dexmedetomidine on restlessness in elderly patients undergoing general anesthesia after knee arthroplasty.Methods 70 elderly patients undergoing knee arthroplasty in our hospital were randomly divided into observation group and control group,with 35 cases in each group.The control group was treated with routine intravenous general anesthesia,and the observation group was pumped with 0.05%intravenous at the beginning of anesthesia induction 0.05μg/kg,20ml dexmedetomidine solution,completed within 15 min.The patients in the two groups were evaluated by SAS restlessness score(VAS)and 24 hours after operation.The levels of norepinephrine(NE)before administration.According to the median SAS level 4 hours after awakening,the observation group was divided into agitation group(SAS>median)and sedation group(SAS≤median).To compare the difference of NSE level between agitation group and sedation group.At the same time,the sensitivity and specificity of predicting dexmedetomidine in the prevention of postoperative agitation and ROC were evaluated with the level of NSE during extubation as a reference.Results 24 hours after operation,the SAS and VAS scores were(3.24±0.64)and(1.84±0.63)respectively with(P<0.05);after the patients woke up,the VAS were increased first and decreased,and the VAS scores in observation group were lower at all time points(P<0.05).NE in observation group was(277.78±44.44),lower than(482.85±76.77)of control group(P<0.05).The observation group was divided into agitation group(SAS>3.26,n=17)and sedation group(SAS≤3.26,n=18)according to the median SAS level of 3.26(range:1.972-4.54)4 hours after awakening.The levels of NSE in agitation group and sedation group were(297.8±47.8)ng/L and(258.9±31.9)ng/L respectively(P<0.05).Taking NSE as a reference,the sensitivity and specificity of predicting whether patients are restless 4 hours after awakening were 68.2%and 66.7%respectively,and the area under the ROC curve was 0.712(P<0.05).Conclusion Dexmedetomidine can alleviate the agitation of elderly patients under general anesthesia after knee arthroplasty.The NE level during extubation can be used as a biomarker for dexmedetomidine to prevent agitation.
作者
罗曼
单世民
Luo Man;Shan Shimin(Department of Anesthesiology,Tianjin Fifth Central Hospital,Tianjin 300451,China)
出处
《首都食品与医药》
2022年第20期63-66,共4页
Capital Food Medicine
关键词
右美托咪定
膝关节置换术
全身麻醉
躁动
Dexmedetomidine
Knee arthroplasty
General anesthesia
Restlessness
