右美托咪啶复合麻醉对高龄股骨近端骨折患者术后谵妄的影响

目的：评价右美托咪啶复合麻醉对高龄股骨近端骨折患者术后谵妄的影响。方法选择高龄股骨近端骨折需外科治疗患者142例，年龄70岁以上， ASA分级I或Ⅱ级。患者随机分为两组：七氟醚－芬太尼组（对照组）和右美托咪啶－七氟醚－芬太尼组（观察组），每组71例。同时详细记录依托咪酯、芬太尼及七氟醚用量、苏醒期躁动及术后24 h内谵妄发生率。结果两组患者年龄、性别、ASA分级及构成比、手术时间、术中出血量比较，差异均无统计学意义（ P＞0．05），提示两组患者具有较高的同质性。观察组与对照组患者芬太尼、依托咪酯、七氟醚的用量及苏醒期躁动和术后谵妄发生率分别为：217±24 ug VS 75．8±5．7 ug，10．1±2．9 mg VS 7．0±2．1 mg，12．1±2．7 mL VS 7．8±2．3 mL，23％ VS 8％，27％ VS 11％，差异均具有统计学意义（ P＜0．05）；而两组患者麻醉恢复时间差异无统计学意义。结论右美托咪啶复合麻醉可有效较少高龄股骨近端骨折患者术中麻药用量、降低苏醒期躁动和术后谵妄发生率，部分患者可以尝试使用右美托咪啶复合麻醉的方式。

Postoperative Delirium of Dexmedetomidine in Elderly Patients with Proximal Femoral Fractures

Objective To evaluate the postoperative delirium of dexmedetomidine combined anesthesia in elderly pa -tients with proximal femoral fractures .Methods 142 patients, who≥70 years old, with proximal femoral fractures , and underwent surgical treatment .ASA grade I or grade Ⅱ.Patients were randomized into two groups:sevoflurane-fentanyl group (control group, 71 cases) and dexmedetomidine -sevoflurane-fentanyl group (study group, 71 cases).Record-ing the consumption of etomidate , fentanyl and sevoflurane , restlessness , and postoperative delirium incidence within 24 h.Results The age, gender, ASA classification and composition ratio , operative time, blood loss of two group were not statistically significant (P>0.05).The consumption of fentanyl, etomidate, sevoflurane and the incidence of restless-ness and postoperative delirium of control and study groups were:217 ±24 ug VS 75.8 ±5.7 ug, 10.1 ±2.9 mg VS 7.0 ±2.1 mg, 12.1 ±2.7 mL VS 7.8 ±2.3 mL, 23% VS 8%, 27% VS 11%, there were statistically significant ( P<0.05).Conclusions Dexmedetomidine combined anesthesia can reduce the consumption of intraoperative anesthetic , reduce the incidence of restlessness and postoperative delirium in elderly patients with proximal femoral fractures .