右美托咪定对老年患者术后镇痛和术后谵妄的影响

目的探讨右美托咪定对老年患者术后镇痛及术后谵妄的影响。方法择期全麻下行骨科手术的老年患者60例,随机分为右美托咪定组(A组)和生理盐水组(B组),每组30例。A组患者麻醉诱导前10 min经静脉泵注0.5μg/kg的右美托咪定,并以0.2μg/(kg?h)持续输注至手术结束。B组患者以生理盐水代替右美托咪定,用法、用量相同。两组患者术后均使用舒芬太尼进行患者自控静脉镇痛(PCIA),观察并记录两组患者术后2、4、6、12、24 h的疼痛VAS评分以及术后12 h和24 h患者PCIA的按压次数,术后7 d内谵妄的发生率。结果两组相比,A组术后12 h和24 h PCIA按压次数明显减少(P<0.05),术后2、4、6 hVAS评分显著降低(P<0.05),谵妄发生率明显降低(P<0.05)。结论右美托咪定能有效增强老年患者术后镇痛效果并且能降低术后谵妄的发生率。

Effect of Dexmedetomidine on Postoperative Analgesia and the Incidence of Postoperative Delirium in Elderly Patients

Objective To investigate the effect of dexmedetomidine on postoperative analgesia and the incidence of postoperative delirium in elderly patients. Methods Sixty elderly patients waiting for the selective orthopaedics operation with general anesthesia were randomly allocated to one of 2 groups （n=30 each）： dexmedetomidine group （A group） and physiological-saline group （B group）. In A group, patients received dexmedetomidine hydrochloride infusion in 10 min using syringe pump （0.5 μg/kg） before induction, then dexmedetomidine was administrated continually at the rate of 0.2 μg/（kg？h） until the end of operation. In B group, physiological-saline was given. All the patients of both groups received patient-controlled intravenous analgesia （PCIA） with sufentanyl. The visual analogue scores（VAS） of pain at the time of 2 h, 4 h, 6 h, 12 h, 24 h post-operation, as well as the times of PCIA in 12 h and 24 h post-operation were recorded. The occurrence of postoperative delirium was evaluated regularly until the seventh postoperative day. Results Compared with B group, the times of PCIA in 12 h and 24 h post-operation was signiifcantly reduced （P〈0.05） and VAS score at the time of 2 h, 4 h, 6 h post-operation decreased （P〈0.05）, as well as the occurrence of postoperative delirium was signiifcantly reduced （P〈0.05） in A group. Conclusion In the elderly patients, intravenous infusion of dexmedetomidine can effectively assist the postoperative analgesic efifcacy and reduce the occurrence of postoperative delirium.