中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
8期
936-938
,共3页
张承华%麻伟青%杨云丽%王慧明%董发团%奚曦%刘洁
張承華%痳偉青%楊雲麗%王慧明%董髮糰%奚晞%劉潔
장승화%마위청%양운려%왕혜명%동발단%해희%류길
右美托咪啶%麻醉,全身%老年人%谵妄%手术后并发症
右美託咪啶%痳醉,全身%老年人%譫妄%手術後併髮癥
우미탁미정%마취,전신%노년인%섬망%수술후병발증
Dexmedetomidine%Anesthesia,general%Aged%Delirium%Postoperative complication
目的 评价右美托咪啶复合麻醉对高龄髋关节置换术患者术后谵妄的影响.方法 择期行全髋关节置换术患者160例,性别不限,年龄75 ～ 85岁,BMI 20 ～ 25 kg/m2,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将患者随机分为2组(n=80):七氟醚-芬太尼组(C组)和右美托咪啶-七氟醚-芬太尼组(D组).D组麻醉诱导前经15 min静脉输注右美托咪啶负荷量0.6 μg/kg,随后以0.2μg·kg-1 ·h-1的速率静脉输注至术毕,C组给予等容量生理盐水.负荷量输注完毕后5min 2组均静脉注射芬太尼2 ～4 μg/kg、依托咪酯0.1～0.3 mg/kg和顺阿曲库铵0.15 mg/kg麻醉诱导,气管插管后行机械通气.麻醉维持:吸入七氟醚(呼气末靶浓度1％～3％),间断静脉注射芬太尼0.05 mg,维持BIS值40～ 60.记录依托咪酯、芬太尼和七氟醚的用量、苏醒期躁动及术后24 h内谵妄发生情况.结果 与C组比较,D组依托咪酯、芬太尼和七氟醚的用量减少,苏醒期躁动发生率及术后24 h内谵妄的发生率降低(P＜0.05).结论 右美托咪啶复合麻醉可降低高龄髋关节置换术患者术后谵妄的发生.
目的 評價右美託咪啶複閤痳醉對高齡髖關節置換術患者術後譫妄的影響.方法 擇期行全髖關節置換術患者160例,性彆不限,年齡75 ～ 85歲,BMI 20 ～ 25 kg/m2,ASA分級Ⅱ或Ⅲ級.採用隨機數字錶法,將患者隨機分為2組(n=80):七氟醚-芬太尼組(C組)和右美託咪啶-七氟醚-芬太尼組(D組).D組痳醉誘導前經15 min靜脈輸註右美託咪啶負荷量0.6 μg/kg,隨後以0.2μg·kg-1 ·h-1的速率靜脈輸註至術畢,C組給予等容量生理鹽水.負荷量輸註完畢後5min 2組均靜脈註射芬太尼2 ～4 μg/kg、依託咪酯0.1～0.3 mg/kg和順阿麯庫銨0.15 mg/kg痳醉誘導,氣管插管後行機械通氣.痳醉維持:吸入七氟醚(呼氣末靶濃度1％～3％),間斷靜脈註射芬太尼0.05 mg,維持BIS值40～ 60.記錄依託咪酯、芬太尼和七氟醚的用量、囌醒期躁動及術後24 h內譫妄髮生情況.結果 與C組比較,D組依託咪酯、芬太尼和七氟醚的用量減少,囌醒期躁動髮生率及術後24 h內譫妄的髮生率降低(P＜0.05).結論 右美託咪啶複閤痳醉可降低高齡髖關節置換術患者術後譫妄的髮生.
목적 평개우미탁미정복합마취대고령관관절치환술환자술후섬망적영향.방법 택기행전관관절치환술환자160례,성별불한,년령75 ～ 85세,BMI 20 ～ 25 kg/m2,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장환자수궤분위2조(n=80):칠불미-분태니조(C조)화우미탁미정-칠불미-분태니조(D조).D조마취유도전경15 min정맥수주우미탁미정부하량0.6 μg/kg,수후이0.2μg·kg-1 ·h-1적속솔정맥수주지술필,C조급여등용량생리염수.부하량수주완필후5min 2조균정맥주사분태니2 ～4 μg/kg、의탁미지0.1～0.3 mg/kg화순아곡고안0.15 mg/kg마취유도,기관삽관후행궤계통기.마취유지:흡입칠불미(호기말파농도1％～3％),간단정맥주사분태니0.05 mg,유지BIS치40～ 60.기록의탁미지、분태니화칠불미적용량、소성기조동급술후24 h내섬망발생정황.결과 여C조비교,D조의탁미지、분태니화칠불미적용량감소,소성기조동발생솔급술후24 h내섬망적발생솔강저(P＜0.05).결론 우미탁미정복합마취가강저고령관관절치환술환자술후섬망적발생.
Objective To investigate the effect of dexmedetomidine combined anesthesia on postoperative delirium in the elderly patients undergoing hip joint replacement.Methods One hundred and sixty ASA Ⅱ or Ⅲ patients,aged 75-85 yr,with a body mass index of 20-25 kg/m2,scheduled for elective total hip joint replacement under general anesthesia,were randomly divided into 2 groups (n =80 each):sevoflurane-fentanyl control group (group C) and dexmedetomidine-sevoflurane-fentanyl group (group D).Dexmedetomidine was intravenously infused at 0.2 μg· kg-1 · h-1 until the end of operation after a loading dose of 0.6μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with iv injection of fentanyl 2-4 μg/kg and etomidate 0.1-0.3 mg/kg at 5 min after the end of administration of the loading dose.Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg and the patients were mechanically ventilated.Anesthesia was maintained with target-controlled inhalation of sevoflurane (the end-tidal concentration 1％-3％) and intermittent iv boluses of fentanyl 0.05 mg.BIS was maintained at 40-60 during operation.The consumption of etomidate,fentanyl,and sevoflurane,agitation during emergence from anesthesia,and postoperative delirium within 24 h after operation were recorded.Results Compared with group C,the consumption of etomidate,fentanly,and sevoflurane was significantly reduced and the incidences of agitation during emergence from anesthesia and postoperative delirium within 24 h after operation were significantly decreased in group D (P ＜0.05).Conclusion Dexmedetomidine combined anesthesia can reduce the occurrence of postoperative delirium in the elderly patients undergoing hip joint replacement.
