中国现代医生
中國現代醫生
중국현대의생
CHINA MODERN DOCTOR
2014年
30期
52-54
,共3页
徐知菲%唐在荣%姚娟%金峰
徐知菲%唐在榮%姚娟%金峰
서지비%당재영%요연%금봉
右美托咪定%老年患者%自控镇痛%术后谵妄
右美託咪定%老年患者%自控鎮痛%術後譫妄
우미탁미정%노년환자%자공진통%술후섬망
Dexmedetomidine%Elderly%PCIA%Postoperative delirium
目的：观察小剂量右美托咪定联合舒芬太尼静脉自控镇痛(PCIA)对老年髋部骨折患者术后谵妄的影响。方法选择腰-硬联合麻醉下择期行髋部骨折手术老年患者60例，年龄65~80岁，ASAⅠ或Ⅱ级，随机分为右美托咪定联合舒芬太尼镇痛组(D组)和舒芬太尼镇痛组(S组)，每组30例。分别于术后6、12、24和48 h采用VAS疼痛评分法进行镇痛评分，并于术前1 d、术后第2、4、6天采用简易智能精神状态检查量表(MMSE)及谵妄评定法(CAM)对患者精神状态进行评估。结果两组患者术后各时点VAS评分均≤4分，两组镇痛评分无统计学差异；D组镇痛泵自控给药次数少于S组(P<0.01)；D组第2、4、6天 MMSE评分高于S组(P<0.05)，CAM谵妄评估D组2例，S组8例(6.7%v s 26.7%)(P<0.05)；两组患者均无呼吸抑制现象。结论小剂量右美托咪定联合舒芬太尼用于老年髋部骨折手术患者PCIA镇痛、镇静效果满意，可降低老年患者术后谵妄的发生率。
目的：觀察小劑量右美託咪定聯閤舒芬太尼靜脈自控鎮痛(PCIA)對老年髖部骨摺患者術後譫妄的影響。方法選擇腰-硬聯閤痳醉下擇期行髖部骨摺手術老年患者60例，年齡65~80歲，ASAⅠ或Ⅱ級，隨機分為右美託咪定聯閤舒芬太尼鎮痛組(D組)和舒芬太尼鎮痛組(S組)，每組30例。分彆于術後6、12、24和48 h採用VAS疼痛評分法進行鎮痛評分，併于術前1 d、術後第2、4、6天採用簡易智能精神狀態檢查量錶(MMSE)及譫妄評定法(CAM)對患者精神狀態進行評估。結果兩組患者術後各時點VAS評分均≤4分，兩組鎮痛評分無統計學差異；D組鎮痛泵自控給藥次數少于S組(P<0.01)；D組第2、4、6天 MMSE評分高于S組(P<0.05)，CAM譫妄評估D組2例，S組8例(6.7%v s 26.7%)(P<0.05)；兩組患者均無呼吸抑製現象。結論小劑量右美託咪定聯閤舒芬太尼用于老年髖部骨摺手術患者PCIA鎮痛、鎮靜效果滿意，可降低老年患者術後譫妄的髮生率。
목적：관찰소제량우미탁미정연합서분태니정맥자공진통(PCIA)대노년관부골절환자술후섬망적영향。방법선택요-경연합마취하택기행관부골절수술노년환자60례，년령65~80세，ASAⅠ혹Ⅱ급，수궤분위우미탁미정연합서분태니진통조(D조)화서분태니진통조(S조)，매조30례。분별우술후6、12、24화48 h채용VAS동통평분법진행진통평분，병우술전1 d、술후제2、4、6천채용간역지능정신상태검사량표(MMSE)급섬망평정법(CAM)대환자정신상태진행평고。결과량조환자술후각시점VAS평분균≤4분，량조진통평분무통계학차이；D조진통빙자공급약차수소우S조(P<0.01)；D조제2、4、6천 MMSE평분고우S조(P<0.05)，CAM섬망평고D조2례，S조8례(6.7%v s 26.7%)(P<0.05)；량조환자균무호흡억제현상。결론소제량우미탁미정연합서분태니용우노년관부골절수술환자PCIA진통、진정효과만의，가강저노년환자술후섬망적발생솔。
Objective To observe the influence of low-dose dexmedetomidine combined with sufentanil PCIA on post-operative delirium in elderly patients undergoing hip fracture surgery. Methods Sixty elderly patients aged 65~80, ASAⅠorII, undergoing elective hip fracture surgery by combined spinal-epidural anesthesia were randomly allocated to receive dexmedetomidine combined with sufentanil PCIA group (group D, n=30) and sufentanil PCIA group (group S, n=30). The scores of visual analogue scales (VAS) was recorded at 6、12、24 and 48 h after operation, and cognitive function was assessed 1 d preoperatively and on the postoperative 2, 4 and 6 d with MMSE and CAM after PCIA. Re-sults The VAS scores in each time point of two groups after operation were both ≤4, there was no significantly differ-ence in the pain score between two groups, in group D, times of press analgesia device was less than that in group S (P<0.01); The MMSE score in D group was higher than that in S group on the postoperative 2, 4 and 6 d (P<0.05) and the incidence of postoperative delirium in group D (n=2) was lower than group S(n=8) (6.7% vs 26.7%)(P<0.05). The patients in the two groups had no respiratory suppression. Conclusion Low-dose dexmedetomidine combined with sufentanil PCIA in elderly patients undergoing hip fracture surgery has satisfactory analgesic effect, and can decrease the incidence of postoperative delirium.
