CAJ | 학술논문

目的：探讨右美托咪啶术中持续小剂量输注对高龄髋关节置换术患者术后谵妄的影响。方法将择期行全髋关节置换术患者120例随机分为 D、C 2组各60例，患者均侧卧位下行腰椎-硬膜外联合阻滞（ CSEA）术，于 L3-4蛛网膜下腔穿刺成功后，注入混合液（0.75%布比卡因2 mL +10%葡萄糖溶液1 mL）1.8 mL，并置入硬膜外导管。调整感觉阻滞平面达 T8，期间静脉补充晶体胶体液维持血流动力学稳定，必要时给予苯肾上腺素或阿托品。血流动力学稳定，麻醉平面达 T8并固定后开始手术。D 组在切皮前静脉开始输注右美托咪啶0.2μg /（kg·h）至术毕，C 组输注等量等速的生理盐水。术中输注液体，必要时应用血管活性药物维持血压波动在基础值的±20%。手术结束时连接硬膜外术后镇痛泵（PCEA）。记录各组高血压、低血压及心动过缓发生的例数以及苯肾上腺素、阿托品、硝酸甘油的用量。根据 ICU 谵妄评估法评估并计算术日（D0）、术后第1天（D1）、术后第2天（D2）、术后第3天（ D3）及术后3 d 内（ D4）谵妄的发生率。结果与 C 组比较，D 组中患者心动过缓发生率显著升高（ P ﹤0.05），需要阿托品治疗的例数显著增多（ P ﹤0.05），2组间高血压和低血压的发生率及苯肾上腺素、硝酸甘油使用剂量比较差异均无统计学意义（ P 均﹥0.05）。与 C 组比较，D 组患者 D0、D1及 D4谵妄发生率显著降低（ P 均﹤0.05），2组患者 D1、D2和 D3谵妄发生率均显著低于 D0（P 均﹤0.05）。结论右美托咪啶持续输注可降低高龄髋关节置换术患者术后谵妄的发生。
목적：탐토우미탁미정술중지속소제량수주대고령관관절치환술환자술후섬망적영향。방법장택기행전관관절치환술환자120례수궤분위 D、C 2조각60례，환자균측와위하행요추-경막외연합조체（ CSEA）술，우 L3-4주망막하강천자성공후，주입혼합액（0.75%포비잡인2 mL +10%포도당용액1 mL）1.8 mL，병치입경막외도관。조정감각조체평면체 T8，기간정맥보충정체효체액유지혈류동역학은정，필요시급여분신상선소혹아탁품。혈류동역학은정，마취평면체 T8병고정후개시수술。D 조재절피전정맥개시수주우미탁미정0.2μg /（kg·h）지술필，C 조수주등량등속적생리염수。술중수주액체，필요시응용혈관활성약물유지혈압파동재기출치적±20%。수술결속시련접경막외술후진통빙（PCEA）。기록각조고혈압、저혈압급심동과완발생적례수이급분신상선소、아탁품、초산감유적용량。근거 ICU 섬망평고법평고병계산술일（D0）、술후제1천（D1）、술후제2천（D2）、술후제3천（ D3）급술후3 d 내（ D4）섬망적발생솔。결과여 C 조비교，D 조중환자심동과완발생솔현저승고（ P ﹤0.05），수요아탁품치료적례수현저증다（ P ﹤0.05），2조간고혈압화저혈압적발생솔급분신상선소、초산감유사용제량비교차이균무통계학의의（ P 균﹥0.05）。여 C 조비교，D 조환자 D0、D1급 D4섬망발생솔현저강저（ P 균﹤0.05），2조환자 D1、D2화 D3섬망발생솔균현저저우 D0（P 균﹤0.05）。결론우미탁미정지속수주가강저고령관관절치환술환자술후섬망적발생。
Objective It is to approach the influence of dexmedetomidine on postoperative delirium in the elderly patients undergoing hip joint replacement. Methods One hundred and twenty patients scheduled for elective total hip joint replacement were randomly divided into dexmedetomidine group(group D)and control group(group C),60 cases in each group. Spinal anesthesia was performed at L3-4 interspace and 1. 8 mL mixture(0. 75% bupivacaine 2 mL combined with 10% glucose solu-tion 1 mL)was injected into the subarachnoid space over 10 s in both groups. Dexmedetomidine was intravenously infused at 0. 2 μg /(kg·h)from the beginning of incision to the end of operation in group D,while the equal volume of normal saline was infused in group C. The cases of hypertension,hypotension and bradycardia,and the does of phenylephrine,atropine and nitroglycerin were observed and recorded. The incidence of delirium in surgery day(D0 ),1st day(D1 ),2nd day(D2 ),3rd day(D3 )and within 3 days after operation(D4 )were evaluated. ResultsCompared with group C,the incidence of bradycardia in group D was markedly increased( P ﹤ 0. 05),and more cases need atropine( P ﹤ 0. 05),but there was no significant difference in incidence of hypertension,hypotension and dosage such as phenylephrine and nitroglycerin between both groups ( all P ﹥ 0. 05). Compared with group C,the incidences of delirium in D0 ,D1 and D4 were significantly decreased in group D (all P ﹤ 0. 05). The incidences of delirium in D1 ,D2 and D3 were markedly decreased in D0( all P ﹤ 0. 05). Conclusion Dexmedetomidine can reduce the occurrence of postoperative delirium in in eldly patients undergoing hip joint replacement.