CAJ | 학술논문

目的：探讨全身麻醉中应用右美托咪定（dexmedetomidine，DEX）是否可减低老年患者非心脏大手术后苏醒期谵妄及术后谵妄的发生率。方法选取2012年1月至2013年12月北京世纪坛医院60岁以上 ASA I-III 级实施肿瘤（胸腔、腹腔及泌尿系统）切除手术的老年患者206例（无抑郁症及精神病史），随机分为2组：右美托咪定组（D组99例）与对照组（C 组107例），记录：两组苏醒期谵妄评估、躁动镇静评分；观察两组术后第1-3天谵妄发生情况，行意识状态评定方法评估及术中情况。结果 D 组发生苏醒期谵妄8例（8．1％），术后谵妄4例（4．0％）；C 组发生苏醒期谵妄25例（23．4％），术后谵妄15例（15．5％）。发生苏醒期谵妄的33例病例中有17例出现了术后谵妄（POD，51．5％），未发生苏醒期谵妄的173例中发生了2例 POD（1．2％），前者 POD 的发生率显著高于后者。结论右美托咪定可以降低老年非心脏大手术患者苏醒期谵妄及术后谵妄的发生率，发生苏醒期谵妄的老年患者更易发生术后谵妄。
목적：탐토전신마취중응용우미탁미정（dexmedetomidine，DEX）시부가감저노년환자비심장대수술후소성기섬망급술후섬망적발생솔。방법선취2012년1월지2013년12월북경세기단의원60세이상 ASA I-III 급실시종류（흉강、복강급비뇨계통）절제수술적노년환자206례（무억욱증급정신병사），수궤분위2조：우미탁미정조（D조99례）여대조조（C 조107례），기록：량조소성기섬망평고、조동진정평분；관찰량조술후제1-3천섬망발생정황，행의식상태평정방법평고급술중정황。결과 D 조발생소성기섬망8례（8．1％），술후섬망4례（4．0％）；C 조발생소성기섬망25례（23．4％），술후섬망15례（15．5％）。발생소성기섬망적33례병례중유17례출현료술후섬망（POD，51．5％），미발생소성기섬망적173례중발생료2례 POD（1．2％），전자 POD 적발생솔현저고우후자。결론우미탁미정가이강저노년비심장대수술환자소성기섬망급술후섬망적발생솔，발생소성기섬망적노년환자경역발생술후섬망。
Objective To observe if dexmedetomidine for non-cardiacsurgery had the effect that decreasing the inci-dence rate of the emergence delirium and the postoperative delirium (POD).To investigate the relation between the e-mergence delirium and the postoperative delirium.Methods There were 206 enrolled patients,depleting the patient who had acute massive haemorrhage,drastic fluctuation and accessed to ICU after operation or rejected to interview.Those patients were allocated into two groups randomly:group D(dexmedetomidine,n=99)and group C (control group,n=107).The same interviewer evaluated the patients for emergence delirium by the Nursing Delirium Screening Scale (Nu-DESC),and Richmond Agitation-Sedation Scale (RASS)in post-anesthetic care unit;and evaluated postoperative deliri-um by the Confusion Assessment Method (CAM)during the first 3 postoperative days;evaluated postoperative cogni-tive dysfunction by the Mini-Mental State Examination (MMSE),cognitive state examination and Back Depression In-ventory (BDI)before the operation and repeated it at 7 days postoperatively.Other information were also monitored. Results The incidence of emergence delirium in group D was 8.1%,POD was 4.0%;and the incidence of emergence delirium in group C was 23.4%,POD was 15.5%.The incidence of POD in emergence delirium patient is 51.5% ,but without emergence delirium is 1.2% ,so the former is significantly higher than the latter.Conclusion Eexmedetomi-dine for non-cardiac surgery had the effect that decreased the incidence rate of the emergence delirium and the postoper-ative delirium.The emergence delirium was prone to the postoperative delirium.