天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2015年
6期
663-665,666
,共4页
张云飞%高伟忠%马世颖%刘金碧
張雲飛%高偉忠%馬世穎%劉金碧
장운비%고위충%마세영%류금벽
麻醉,硬膜外%认知障碍%手术后期间%老年人%右美托咪定
痳醉,硬膜外%認知障礙%手術後期間%老年人%右美託咪定
마취,경막외%인지장애%수술후기간%노년인%우미탁미정
anesthesia,epidural%cognition disorder%postoperative period%aged%Dexmedetomidine
目的：观察硬膜外麻醉复合不同剂量右美托咪定对老年人髋部手术后循环和认知功能障碍（POCD）的影响。方法选择2013年6月—2014年9月，65岁以上髋部手术患者120例，行硬膜外麻醉联合右美托咪定静脉泵注，按右美托咪定的泵注量不同，分为A组0.2μg·h-1·kg-1，B组0.4μg·h-1·kg-1和C组0.6μg·h-1·kg-1，每组40例。观察并记录3组患者入室时（T0）、用药后10 min（T1）、用药后20 min（T2）、停药即刻（T3）、停药后10 min（T4）以及手术完毕时（T5）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）。应用简易智力状态量表（MMSE）测试3组患者术前24 h（t1）、术后12 h（t2）、术后24 h（t3）及术后72 h（t4）认知功能。结果3组患者在T0时MAP、HR及SpO2比较差异无统计学意义；C组T2、T3时HR和MAP均较A组、B组明显下降（均P<0.05）。3组术前MMSE评分差异无统计学意义，B组t2、t3时的MMSE评分均明显高于A组和C组（P<0.05）；B组POCD发生率明显低于A组和C组（P<0.05）。结论硬膜外麻醉复合右美托咪定以0.4μg·h-1·kg-1静脉泵注对老年患者的循环干扰小，可减少老年患者围手术期认知功能障碍的发生。
目的：觀察硬膜外痳醉複閤不同劑量右美託咪定對老年人髖部手術後循環和認知功能障礙（POCD）的影響。方法選擇2013年6月—2014年9月，65歲以上髖部手術患者120例，行硬膜外痳醉聯閤右美託咪定靜脈泵註，按右美託咪定的泵註量不同，分為A組0.2μg·h-1·kg-1，B組0.4μg·h-1·kg-1和C組0.6μg·h-1·kg-1，每組40例。觀察併記錄3組患者入室時（T0）、用藥後10 min（T1）、用藥後20 min（T2）、停藥即刻（T3）、停藥後10 min（T4）以及手術完畢時（T5）的心率（HR）、平均動脈壓（MAP）、血氧飽和度（SpO2）。應用簡易智力狀態量錶（MMSE）測試3組患者術前24 h（t1）、術後12 h（t2）、術後24 h（t3）及術後72 h（t4）認知功能。結果3組患者在T0時MAP、HR及SpO2比較差異無統計學意義；C組T2、T3時HR和MAP均較A組、B組明顯下降（均P<0.05）。3組術前MMSE評分差異無統計學意義，B組t2、t3時的MMSE評分均明顯高于A組和C組（P<0.05）；B組POCD髮生率明顯低于A組和C組（P<0.05）。結論硬膜外痳醉複閤右美託咪定以0.4μg·h-1·kg-1靜脈泵註對老年患者的循環榦擾小，可減少老年患者圍手術期認知功能障礙的髮生。
목적：관찰경막외마취복합불동제량우미탁미정대노년인관부수술후순배화인지공능장애（POCD）적영향。방법선택2013년6월—2014년9월，65세이상관부수술환자120례，행경막외마취연합우미탁미정정맥빙주，안우미탁미정적빙주량불동，분위A조0.2μg·h-1·kg-1，B조0.4μg·h-1·kg-1화C조0.6μg·h-1·kg-1，매조40례。관찰병기록3조환자입실시（T0）、용약후10 min（T1）、용약후20 min（T2）、정약즉각（T3）、정약후10 min（T4）이급수술완필시（T5）적심솔（HR）、평균동맥압（MAP）、혈양포화도（SpO2）。응용간역지력상태량표（MMSE）측시3조환자술전24 h（t1）、술후12 h（t2）、술후24 h（t3）급술후72 h（t4）인지공능。결과3조환자재T0시MAP、HR급SpO2비교차이무통계학의의；C조T2、T3시HR화MAP균교A조、B조명현하강（균P<0.05）。3조술전MMSE평분차이무통계학의의，B조t2、t3시적MMSE평분균명현고우A조화C조（P<0.05）；B조POCD발생솔명현저우A조화C조（P<0.05）。결론경막외마취복합우미탁미정이0.4μg·h-1·kg-1정맥빙주대노년환자적순배간우소，가감소노년환자위수술기인지공능장애적발생。
Objective To observe the effect of a variety dosage of dexmedetomidine on circulatory and cognitive func?tions in elderly patients who underwent hip orthopedic surgery. Methods A total of 120 patients who underwent hip ortho?pedic surgery, with age over 65 years old were recruited from 06/2013 to 09/2014 and were administered intravenously dex?medetomidine after epidural anesthesia. Based on the dosage of dexmedetomidine, patients were randomly divided into 3 groups with 40 cases in each group:Group A were given 0.2μg·h-1·kg-1 dexmedetomidine;Group B were given dexmedeto?midine 0.4μg · h-1 · kg-1, and group C were given 0.6μg · h-1 · kg-1. The heart rate (HR),mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at 6 time points, including the time entering operating room (T0), 10 min (T1), 20 min (T2) after drug administration, the time of drug withdrawal (T3), 10 min after drug withdrawal (T4) and the terminal time of surgery (T5) respectively. Cognitive function was evaluated by mini-mental state examination (MMSE) at the time points of 24 hours before surgery (t1), 12 hours (t2), 24 hours (t3), and 72 hours (t4) after surgery. Results All 3 groups of pa?tients show no significant difference of MAP, HR and SpO2 at T0 (P>0. 05).A significant decrease in MAP and HR were ob?served in Group C at T2 and T3 time points compared to those in Group A or Group B (P<0.05). There was no significant dif?ference in MMSE at time point T1 among all three groups (P > 0.05). However, compared to that in group A or group C, MMSE increased significantly at time point T2, T3 in group B (P<0.05). In addition, compared to group A or group C, the pa?tients in group B exhibited lower incidence of postoperative cognitive function disorder (P < 0.05). Conclusion Continu?ous intravenous infusion of Dexmedetomidine can be used in elderly patient who underwent hip orthopedic surgery at the dose of 0.4μg·h-1·kg-1 safely with little interference to circulatory and cognitive function in perioperative period.
