中国冶金工业医学杂志

小剂量右美托咪定用于PCIA对老年髋部骨折患者术后早期认知功能的影响

单位：上海中冶医院麻醉科上海 200941

分类号：

出版年,卷(期):页码：2017,34(3):253-254

摘要：

摘要：目的评价小剂量右美托咪定复合舒芬太尼用于术后自控静脉镇痛（PCIA）对老年髋部骨折患者术后早期认知功能的影响。方法选取65岁以上择期于腰硬联合麻醉(CSEA)下行髋部骨折手术治疗并要求术后镇痛的患者60例，ASA分级Ⅱ~Ⅲ级，随机分为A组（右美托咪定25 μg/kg复合舒芬太尼组）和B组（舒芬太尼组），每组各30例。于术后6、12、24、48 h用视觉模拟评分法（VAS）评估患者疼痛程度；于术后1~3 d采用意识错乱评估法(CAM)评估术后谵妄(POD)的发生情况；于术前1 d、术后第3、7 d采用简易精神状态量表（MMSE）评估术后认知功能障碍(POCD)的发生情况。结果A组患者VAS评分术后12、24、48 h均低于B组（P＜005）；A组镇痛泵自控给药次数少于B组(P＜005)；A组和B组分别有2例(667 %)和8例(2667 %)患者发生POD，差异有统计学意义(χ2=4320，P＜005)；A组术后第7 d的MMSE评分高于B组（P＜005），但A、B两组POCD发生率分别为1333 %和30 %，差异无统计学意义(P＞005)。结论小剂量右美托咪定联合舒芬太尼用于术后镇痛可以改善老年髋部骨折患者术后镇痛效果和术后早期认知功能。

关键词：右美托咪定；老年患者；自控镇痛；认知功能；髋部骨折

Abstract:Objective To evaluate the effect of low\|dose dexmedetomidine combined with sufentanil in patient\|controlled intravenous analgesia(PCIA)on early postoperative cognition in elderly patients after hip fracture surgeryMethodsSixty patients aged more than 65 yrs with ASA Ⅰ~Ⅲ undergoing hip fracture surgery by combined spinal\|epidural anesthesia(CSEA)and requires postoperative analgesia were randomly assigned into two groups：Group A received PCIA with dexmedetomidine and sufentanil(n=30),Group B received PCIA with only sufentanil(n=30)．The scores of visual analogue scales(VAS)was recorded at 6 h、12 h、24 h、48 h after operationPostoperative Delirium(POD)was assessed within three days after surgery with the confusion assessment method(CAM),and postoperative cognitive dysfunction(POCD)was assessed by mini mental state examination(MMSE) on 1 day before operation and 3, 7 days after operationResultsThe VAS scores at 12 to 48 h after surgery were lower in group A than those in group B(P＜005),the total pressing times of analgesia pump within 48 h in group A were less than those in group B(P＜005) POD was present in 2(667％)patients in group A and 8(2667％)patients in group B (χ2=4320，P＜005)The MMSE score in group A was higher than that in group B on 7 days postoperative(P＜005),but there was no significant difference in the incidence rate of POCD in group A（1333%）vs group B（30%）(P＞005)ConclusionsLow\|dose dexmedetomidine combined with sufentanil for postoperative analgesia in elderly patients after hip fracture surgery can improve the effect of analgesia and early cognitive function after operation．

Key Words:Dexmedetomidine;Elderly patients;Patient\|controlled intravenous analgesia;Cognition;Hip fracture

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作者简介：

参考文献：

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\[2\]杨娜瑜，姜丽华老年患者术后谵妄的研究进展\[J\]临床麻醉学杂志，2013，29(10):1039\|1040

\[3\]Rizk P，Morris W，Oladeji P，et alReview of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery\[J\]Geriatric Orthopaedic Surgery & Rehabilitation，2016，7(2):100\|105

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\[5\]Chen J，Yan J，Han XDexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients\[J\]Exp Ther Med，2013，5(2):489\|494．

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