右美托咪定复合不同麻醉深度对老年全髋关节置换术患者术后谵妄的影响

徐孟婷; 凌云志; 张景俊; 徐晖

doi:10.16766/j.cnki.issn.1674-4152.002132

右美托咪定复合不同麻醉深度对老年全髋关节置换术患者术后谵妄的影响

doi: 10.16766/j.cnki.issn.1674-4152.002132

1.
蚌埠医学院研究生院，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院麻醉科，安徽蚌埠 233004
3.
蚌埠市第三人民医院麻醉科，安徽蚌埠 233000

基金项目:

安徽省高等学校自然科学研究重点项目 KJ2019A0330

蚌埠医学院自然科学基金项目 BYKY18181

详细信息

通讯作者:
徐晖，E-mail: bbxuhui@hotmail.com

中图分类号: R614.24 R687.4
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- 文章访问数: 95
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-25
- 网络出版日期: 2022-02-15

Effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients undergoing total hip replacement

1.
Graduated School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨分析右美托咪定复合不同麻醉深度对行全髋关节置换术的老年患者术后意识障碍及谵妄发生率的影响。方法选取2018年12月—2020年5月于蚌埠医学院第一附属医院就诊，并行全髋关节置换术的96例老年患者为研究对象，根据其脑电双频指数(BIS)不同分为3组，A组BIS值为40~49(32例)，B组BIS值为50~59(35例)，C组BIS值为60~69(29例)，观察比较3组患者术后意识障碍程度、血清神经元特异性烯醇化酶(NSE)和S100β蛋白浓度及谵妄发生情况。结果术后意识障碍程度对比，术后72 h简易精神状态评价量表(MMSE)评分组间比较差异有统计学意义(P＜0.05)，B组术后72 h MMSE评分高于A组、C组(均P＜0.05)，A组与C组比较差异无统计学意义(P＞0.05)；术后72 h NSE和血清S100β蛋白浓度组间比较差异有统计学意义(均P＜0.05)，B组术后72 h NSE和血清S100β蛋白浓度低于A、C组(均P＜0.05)，A组与C组NSE和血清S100β蛋白浓度差异无统计学意义(均P＞0.05)；3组患者术后72 h内发生谵妄分别有8例(25.00%)、1例(2.86%)、7例(24.14%)，组间比较差异有统计学意义(P＜0.05)，B组术后谵妄发生率低于A组、C组(均P＜0.017)，A组与C组术后谵妄发生率比较差异无统计学意义(P＞0.017)。结论对进行全髋关节置换术的老年患者予以右美托咪定复合麻醉深度控制在50~59范围最佳，不仅可有效改善其NSE和血清S100β蛋白浓度，还可降低术后意识障碍程度以及谵妄的发生率。
- 全髋关节置换术 /
- 右美托咪定 /
- 复合不同麻醉深度 /
- 术后谵妄 /
- 影响
Abstract: Objective To investigate the effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients with total hip replacement. Methods A total of 96 elderly patients undergoing total hip arthroplasty in our hospital from December 2018 to May 2020 were selected and divided into three groups according to their bispectral index (BIS). The BIS values of groups A, B and C were 40-49 (n=32), 50-59 (n=35) and 60-69 (n=29), respectively. The degree of consciousness disturbance, serum neuron-specific enolase (NSE), serum S100β protein concentration and delirium were observed and compared amongst the three groups. Results The Mini-Mental State Examination (MMSE) scores of the three groups were significantly different (P < 0.05). The MMSE score of group B was higher than that of groups A and C (all P < 0.05), but no significant difference was observed between group A and group C (P>0.05). Compared with NSE and serum S100β protein concentration before operation, NSE and serum S100β protein concentration at 72 h after operation were significantly different amongst the three groups (all P < 0.05). NSE and serum S100β protein concentrations in group B were lower than those in groups A and C (all P < 0.05), but no difference was observed between group A and group C in terms of NSE and serum S100 β protein concentration (all P>0.05). Eight cases (25.00%), 1 case (2.86%) and 7 cases (24.14%) of delirium were observed in groups A, B and C within 72 h after operation, respectively. A significant difference was observed between the three groups (P < 0.05). The incidence of postoperative delirium in group B was lower than that in groups A and C (all P < 0.017), but no difference was observed between group A and group C (P>0.017). Conclusion Dexmedetomidine combined with anaesthesia depth range of 50-59 can not only effectively improve the NSE and serum S100β protein concentration, but also reduce the degree of postoperative consciousness disturbance and delirium in elderly patients undergoing total hip replacement.
- Total hip arthroplasty /
- Dexmedetomidine /
- Different depth of anaesthesia /
- Postoperative delirium /
- Influence

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表 1 3组行全髋关节置换术的患者一般资料比较

组别	例数	性别[例(%)]		年龄(x ±s，岁)	体重(x ±s，kg)	侧别[例(%)]		ASA分级[例(%)]
组别	例数	男性	女性	年龄(x ±s，岁)	体重(x ±s，kg)	左侧	右侧	Ⅰ级	Ⅱ级	Ⅲ级
A组	32	18(56.25)	14(43.75)	67.16±5.05	54.06±6.52	15(46.88)	17(53.13)	13(40.63)	12(37.50)	7(21.87)
B组	35	17(48.57)	18(51.43)	67.21±4.60	53.83±9.40	17(48.57)	18(51.43)	13(37.14)	14(40.00)	8(22.86)
C组	29	13(44.83)	16(55.17)	68.03±4.14	53.35±8.50	15(51.72)	14(48.28)	11(37.93)	9(31.03)	9(31.03)
统计量		0.839^a		0.337^b	0.059^b	0.146^a			0.302^c
P值		0.657		0.715	0.942	0.929			0.860
注：^a为χ²值，^b为F值，^c为Hc值。

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表 2 3组行髋关节置换术的患者手术前后MMSE评分对比(x ±s，分)

组别	例数	术前	术后72 h
A组	32	28.31±1.06	26.66±1.41^a
B组	35	28.46±1.04	27.63±1.19^abc
C组	29	28.38±1.02	26.76±1.60^a
F值		0.163	4.923
P值		0.850	0.009
注：与同组术前比较，^aP＜0.05;与A组比较，^bP＜0.05;与C组比较，^cP＜0.05。

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表 3 3组行髋关节置换术的患者手术前后血清NSE和S100β蛋白浓度对比(x ±s，μg/L)

组别	例数	NSE		S100β
组别	例数	术前	术后72 h	术前	术后72 h
A组	32	5.59±1.58	10.34±2.04^a	0.18±0.08	0.80±0.23^a
B组	35	5.37±1.19	9.40±1.74^ab	0.18±0.07	0.59±0.15^abc
C组	29	5.41±1.35	11.17±1.91^a	0.20±0.09	0.82±0.22^a
F值		0.239	7.000	0.433	13.869
P值		0.788	0.001	0.650	< 0.001
注：与同组术前比较，^aP＜0.05;与A组比较，^bP＜0.05;与C组比较，^cP＜0.05。

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表 4 3组行髋关节置换术的患者术后谵妄发生情况对比[例(%)]

组别	例数	无谵妄	可能谵妄	谵妄	总发生
A组	32	24(75.00)	3(9.38)	5(15.63)	8(25.01)
B组	35	34(97.14)	1(2.86)	0(0.00)	1(2.86)^ab
C组	29	22(75.86)	3(10.34)	4(13.79)	7(24.14)
注：3组术后谵妄总发生率比较，χ²=8.548，P=0.013。采用卡方分割法，与A组比较，^aP＜0.017;与C组比较，^bP＜0.017。

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参考文献(21)

[1]	戴传强, 秦磊磊, 黄伟, 等. 老年关节置换患者发生术后谵妄的影响因素分析[J]. 中国煤炭工业医学杂志, 2020, 23(2): 97-102. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY202002021.htm
[2]	高志祥, 姜义山, 龙能吉, 等. 老年髋关节置换术后患者发生谵妄的危险因素[J]. 中国组织工程研究, 2019, 22(32): 1255-1256. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201932005.htm
[3]	王博杰, 郭超, 李春晶, 等. 术后早期谵妄对关节置换术老年患者预后的影响[J]. 中华麻醉学杂志, 2018, 38(2): 129-132. doi: 10.3760/cma.j.issn.0254-1416.2018.02.001
[4]	薛维, 张书琼, 向莲. 应用美国国立卫生院卒中量表和简易精神状态量表评价脑出血患者早期康复干预的疗效[J]. 中国临床康复, 2004, 7(25): 31-32. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF200425011.htm
[5]	吴宇洁, 石中永, 王美娟, 等. 记忆谵妄评定量表中文版测评老年术后患者的效度和信度[J]. 中国心理卫生杂志, 2014, 28(12): 937-941. doi: 10.3969/j.issn.1000-6729.2014.12.011
[6]	SCHOLZ A F M, OLDROYD C, MCCARTHY K, et al. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery[J]. Br J Surg, 2016, 103(2): 21-28. doi: 10.1002/bjs.10062
[7]	肖晖, 鲁信星. 不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者术后认知功能的影响[J]. 临床误诊误治, 2018, 31(11): 61-66. doi: 10.3969/j.issn.1002-3429.2018.11.014
[8]	魏林志, 曲宁. 针药复合麻醉对老年全髋关节置换术患者的应激状态及认知功能的影响[J]. 海南医学院学报, 2019, 25(17): 1342-1346. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201917015.htm
[9]	LI Y N, ZHANG Q, YIN C P, et al. Effects of nimodipine on postoperative delirium in elderly under general anesthesia[J]. Medicine, 2017, 96(19): e6849. DOI: 10.1097/MD.0000000000006849.
[10]	侯瑞雪, 王宏, 陈莲华, 等. 神经阻滞复合不同麻醉深度的全身麻醉对老年膝关节置换手术患者术后认知功能的影响[J]. 上海医学, 2018, 40(5): 289-292. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYX201805011.htm
[11]	肖慧, 高钰琳, 丁宁. 术中麻醉深度监测对腹部手术患者PACU谵妄发生和护理质量提升的影响[J]. 广东医学, 2018, 39(21): 3292-3294. doi: 10.3969/j.issn.1001-9448.2018.21.033
[12]	代党会, 陈燕, 李军, 等. 镇静深度对老年骨折患者术后认知功能及谵妄发生率的影响[J]. 国际精神病学杂志, 2020, 47(1): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202001039.htm
[13]	SUN Y, LI Y, SUN Y, et al. Dexmedetomidine effect on emergence agitation and delirium in children undergoing laparoscopic hernia repair: A preliminary study[J]. J Int Med Res, 2017, 45(3): 973-983. doi: 10.1177/0300060517699467
[14]	PARK S W, CHOI J H, KIM H T, et al. Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia[J]. Medicine, 2018, 97(39): e12565. DOI: 10.1097/MD.0000000000012565.
[15]	王伟, 彭文勇. 右美托咪啶联合丙泊酚对老年椎间盘突出全麻患者术后谵妄的效果观察及药代动力学研究[J]. 中华全科医学, 2016, 14(6): 944-946. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201606020.htm
[16]	彭蓓, 彭志勇, 郑利民, 等. 不同剂量右美托咪定联合舒芬太尼对老年髋关节置换患者术后功能恢复与谵妄的影响[J]. 实用药物与临床, 2019, 22(5): 485-488. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC201905009.htm
[17]	DEINER S, LUO X, LIN H M, et al. Intraoperative Infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: A randomized clinical trial[J]. JAMA Surg, 2017, 152(8): 171505. doi: 10.1001/jamasurg.2017.1505
[18]	齐孟娜, 于永浩. 不同麻醉深度对老龄大鼠术后谵妄的影响及可能机制[J]. 实用医学杂志, 2017, 33(1): 63. doi: 10.3969/j.issn.1006-5725.2017.01.017
[19]	蔡世宏, 徐栋, 林学正, 等. 脑电双频指数指导下的丙泊酚闭环靶控输注系统在结直肠癌手术中的应用效果[J]. 中华全科医学, 2020, 18(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202001010.htm
[20]	王贵方, 尚平福, 王涛. 老年全髋关节置换术后谵妄与围术期炎症因子水平的相关性研究[J]. 实用骨科杂志, 2017, 23(4): 22-24. https://www.cnki.com.cn/Article/CJFDTOTAL-SGKZ201704005.htm
[21]	KASSIE G M, NGUYEN T A, ELLETT L M K, et al. Preoperative medication use and postoperative delirium: A systematic review[J]. Bmc Geriatr, 2017, 17(1): 298. doi: 10.1186/s12877-017-0695-x