右美托嘧啶对老年髋部骨折患者术后谵妄的预防作用

承德医学院学报 ›› 2018, Vol. 35 ›› Issue (6): 460-463.

右美托嘧啶对老年髋部骨折患者术后谵妄的预防作用

张义, 侯敬, 谷锐, 张擎柱^△, 金宇

承德医学院附属医院,河北承德 067000

收稿日期:2018-08-18 出版日期:2018-12-10 发布日期:2021-11-21
通讯作者: △

PREVENTIVE EFFECTS OF DEXMEDETOMIDINE ON POSTOPERATIVE DELIRIUM OF ELDERLY HIP FRACTURE PATIENTS

<a href="http://tougao.cdmc.edu.cn:8088/EN/article/advancedSearchResult.do?searchSQL=(((ZHANG Yi[Author]) AND 1[Journal]) AND year[Order])" target="_blank">ZHANG Yi</a>,<a href="http://tougao.cdmc.edu.cn:8088/EN/article/advancedSearchResult.do?searchSQL=((( HOU Jing[Author]) AND 1[Journal]) AND year[Order])" target="_blank"> HOU Jing</a>,<a href="http://tougao.cdmc.edu.cn:8088/EN/article/advancedSearchResult.do?searchSQL=((( GU Rui[Author]) AND 1[Journal]) AND year[Order])" target="_blank"> GU Rui</a>,<a href="http://tougao.cdmc.edu.cn:8088/EN/article/advancedSearchResult.do?searchSQL=((( et al[Author]) AND 1[Journal]) AND year[Order])" target="_blank"> et al</a>

the Affiliated Hospital of Chengde Medical College, Hebei Chengde 067000, China

Received:2018-08-18 Online:2018-12-10 Published:2021-11-21

摘要/Abstract

摘要： 目的: 探讨右美托嘧啶对老年髋部骨折患者术后谵妄的预防作用。方法: 80例老年髋部骨折患者,随机分为实验组（n=40）和对照组（n=40）。两组患者均行髋部骨折手术,实验组患者自术后第0d至术后第1d 6:00给予右美托嘧啶（0.2μg/kg/h）静脉输注,对照组给予0.9%氯化钠注射液静脉输注。比较两组患者术后谵妄发病率、术后疼痛和睡眠质量NRS评分,术后镇痛药地佐辛使用量及药物不良反应发生情况。结果: 实验组术后谵妄发病率,睡眠质量NRS评分,地佐辛使用量及低氧血症发生率均显著低于对照组（P<0.05）。结论: 右美托嘧啶可有效预防老年髋部骨折术后谵妄的发生。

关键词: 右美托嘧啶, 谵妄, 老年患者, 髋部骨折

Abstract: Objective: To investigate the preventive effects of dexmedetomidine on postoperative delirium of elderly hip fracture patients. Methods: 80 cases elderly hip fracture patients were randomly divided into experimental group (n=40) and control group (n=40), and all the patients underwent hip fracture surgery. Then, the patients in experimental group were given dexmedetomidine (0.2μg/kg/h) from the operation day after operation to 6:00 of the first day after operation; While the patients in control group were given 0.9% sodium chloride injection. The incidence of postoperative delirium and adverse reactions, postoperative pain NRS score, postoperative sleep quality NRS score and postoperative dezocine dosage of patients in 2 groups were compared. Results: The incidence of postoperative delirium and hyoxemia, postoperative sleep quality NRS score and postoperative dezocine dosage of patients in experimental group were all obviously lower than control group (P<0.05). Conclusions: Dexmedetomidine can prevent postoperative delirium of elderly hip fracture patients effectively.

Key words: Dexmedetomidine, Delirium, Elderly patients, Hip fracture

中图分类号:

R453.9

张义, 侯敬, 谷锐, 张擎柱, 金宇. 右美托嘧啶对老年髋部骨折患者术后谵妄的预防作用[J]. 承德医学院学报, 2018, 35(6): 460-463.

ZHANG Yi, HOU Jing, GU Rui, et al. PREVENTIVE EFFECTS OF DEXMEDETOMIDINE ON POSTOPERATIVE DELIRIUM OF ELDERLY HIP FRACTURE PATIENTS[J]. Journal of Chengde Medical University, 2018, 35(6): 460-463.

参考文献

[1] 刘强,吴斗.老年股骨颈骨折围手术期治疗[J].中华骨科杂志,2015,35(10):1027-1034.
[2] Trzepacz PT, Delirium. Advances in diagnosis, pathophysiology, and treatment[J]. Psychiatr Clin North Am, 1996, 19(3): 429-448.
[3] Lee KH, Ha YC, Lee YK, et al.Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery[J]. Clin Orthop Relat Res, 2011, 469(9): 2612-2620.
[4] Lin YY, He B, Chen J, et al.Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis[J]. Crit Care, 2012, 16(5): R169.
[5] Ely EW, Inouye SK, Bernard GR, et al.Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710.
[6] Dasgupta M, Dumbrell AC.Preoperative risk assessment for delirium after noncardiac surgery: a systematic review[J]. J Am Geriatr Soc, 2006, 54(10): 1578-1589.
[7] Vochteloo AJ, Moerman S,van der Burg BL, et al. Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients,but does not reduce the incidence of delirium[J]. BMC Geriatr, 2011, 11: 39.
[8] Gustafson Y.Postoperative delirium--a challenge for the orthopedic team[J]. Acta Orthop Scand, 2004, 75(4): 375-377.
[9] 沈健,陈家伟,尹华,等.右旋美托嘧啶对术中镇静药量和术后谵妄的影响[J].中国临床医学,2011,18(6):838-841.
[10] Morrison RS, Magaziner J, Gilbert M, et al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture[J]. J Gerontol A Biol Sci Med Sci, 2003, 58(1): 76-81.
[11] Pandharipande PP, Pun BT, Herr DL, et al.Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial[J]. JAMA, 2007, 298(22): 2644-2653.
[12] Flink BJ, Rivelli SK, Cox EA, et al.Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly[J]. Anesthesiology, 2012, 116(4): 788-796.
[13] 张大志,王东信.麻醉对术后谵妄的影响[J].临床麻醉学杂志,2014,30(1):97-99.
[14] Oto J, Yamamoto K, Koike S, et al.Sleep quality of mechanically ventilated patients sedated with dexmedetomidine[J]. Intensive Care Med, 2012, 38(12): 1982-1989.