右美托咪定对骨科老年患者术后谵妄的影响

目的观察右美托咪定对骨科老年患者术后谵妄发生率的影响。方法选择全麻下行择期骨科手术老年患者100例，随机分为右美托咪定组（D组）和对照组（c组）。D组在气管插管后采用注射泵以0．5μg／（kg·h）速率持续静脉注射，c组以相同方法静脉注射0．9％氯化钠溶液。两组均术毕前20min内停止注射。记录术中七氟醚和芬太尼用量、术后VAS评分、术后Ramsay镇静评分、术后谵妄的发生率。结果两组患者芬太尼和七氟醚用量、VAS评分、Ramsay镇静评分、舒适度评分、术后谵妄的发生率差异有统计学意义（P〈0．05）。与C组对比，D组患者术后谵妄的发生率降低，芬太尼和七氟醚用量减少，Ramsay镇静评分和舒适度评分更优，VAS评分降低（P〈0．05）。结论右美托咪定能减少骨科老年患者术后谵妄的发生率，其机理可能与其提供良好的镇静、镇痛和减少麻醉药物用量有关。

The influence of dexmedetomidine on postoperative delirium in elderly orthopedic patients

Objective To evaluate the effects of dexmedetomidine on the incidence of postoperative delirium in elderly orthopedic patients under general anesthesia. Methods One hundred elderly patients aged more than 60 years old undergoing elective orthopedic surgery ASA II - III were randomly divided into 2 groups （n=50）： dexmedetomidine group （group D） and normal group （group C）. In dexmedetomidine group the patients received dexmedetomidine by a continuous infusion at 0.5μg/（kg·h） till 30 min before the end of operation. The patients in control group were administered with the same amount of normal saline. The Confusion Assessment Method（CAM） was applied to evaluate postoperative delirium ld after operation. Results There were no statistical significant differences in age, gender, weight, operation time, anesthesia time, bleeding of the patients between two groups （P〉0.05）. Compared with patients in group C, patients in group D had lower incidence rate of delirium and fentanyl and sevoflurane consumption. Conclusion Dexmedetomidine displays a prominent sedative effect and decrease the dosage of fentanyl and sevoflurane in general aneasthesia and the incidence rate of delirium in elderly orthopedic patients under general anesthesia.