右美托咪定和丙泊酚对髋部骨折手术患者术后镇静效果及谵妄的影响
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摘要
目的:探讨右美托咪定和丙泊酚对髋部骨折手术患者术后镇静效果及谵妄改善效果的影响。方法:选取2016年4月-2018年3月于我院行髋部骨折手术的108例患者作为研究对象,按随机数字表法分为观察组(n=54)和对照组(n=54),两组患者术中均采用全身静脉麻醉,观察组患者给予右美托咪定进行镇静诱导,对照组患者给予丙泊酚进行镇静诱导。术后24h,采用Ramsay镇静评分评价两组患者术后的镇静效果,采用视觉模拟量表(VAS)评分评价术后镇痛效果,术后1周,对两组患者术后谵妄发生率、谵妄评定量表(CAM)评分、简易智能精神状态检查量表(MMSE)评分进行比较,记录不良反应发生情况。结果:术后24h,观察组患者的Ramsay镇静评分高于对照组,VAS评分及镇痛药追加量低于对照组,差异有统计学意义(P<0.05)。术后1周,观察组患者谵妄发生率、CAM评分低于对照组,MMSE评分高于对照组,差异有统计意义(P<0.05)。观察组不良反应发生率为9.26%,与对照组的14.81%比较,差异无统计学意义(P>0.05)。结论:与丙泊酚相比,髋部骨折手术患者应用右美托咪定可获得更好的术后镇静、镇痛效果,能够降低谵妄的发生率,且无严重不良反应发生,有较高的临床应用价值。
Objective: To observe the effect of dexmedetomidin and propofol on postoperative sedative effect and delirium in patients undergoing hip fracture surgery. Methods: 108 patients who underwent hip fracture surgery in our hospital from April 2016 to March 2018 were selected as the research object. The patients were divided into the observation group(n=54) and the control group(n=54) according to the random number table, total body intravenous anesthesia was used in the two group, the patients in the observation group were given sedation induced by dexmedetomidine, the patients in the control group were given sedation induced by propofol. 24 h after operation, Ramsay sedation score was used to evaluate the sedative effect of the two groups after operation, the visual analogue scale(VAS) score was used to evaluate the effect of postoperative analgesia. 1 week after operation, the incidence of postoperative delirium, delirium Rating Scale(CAM) score, mini mental state examination scale(MMSE) score were compared between the two groups. The occurrence of adverse reactions was recorded. Results: 24 h after operation, the Ramsay sedation score in the observation group was higher than that in the control group, and the VAS score and the dosage of analgesics were lower than those in the control group, the differences were statistically significant(P<0.05). 1 weeks after the operation, the incidence of delirium in the observation group and the CAM score were lower than those in the control group, and the MMSE score was higher than that of the control group, the differences were statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 9.26%, compared with14.81% of the control group, the difference was not statistically significant(P >0.05). Conclusion: Compared with propofol,dexmedetomidine can achieve better sedative, analgesic effects and reduce the incidence of delirium in patients with hip fracture surgery,there is no serious adverse reaction and high clinical value.
Objective: To observe the effect of dexmedetomidin and propofol on postoperative sedative effect and delirium in patients undergoing hip fracture surgery. Methods: 108 patients who underwent hip fracture surgery in our hospital from April 2016 to March 2018 were selected as the research object. The patients were divided into the observation group(n=54) and the control group(n=54) according to the random number table, total body intravenous anesthesia was used in the two group, the patients in the observation group were given sedation induced by dexmedetomidine, the patients in the control group were given sedation induced by propofol. 24 h after operation, Ramsay sedation score was used to evaluate the sedative effect of the two groups after operation, the visual analogue scale(VAS) score was used to evaluate the effect of postoperative analgesia. 1 week after operation, the incidence of postoperative delirium, delirium Rating Scale(CAM) score, mini mental state examination scale(MMSE) score were compared between the two groups. The occurrence of adverse reactions was recorded. Results: 24 h after operation, the Ramsay sedation score in the observation group was higher than that in the control group, and the VAS score and the dosage of analgesics were lower than those in the control group, the differences were statistically significant(P<0.05). 1 weeks after the operation, the incidence of delirium in the observation group and the CAM score were lower than those in the control group, and the MMSE score was higher than that of the control group, the differences were statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 9.26%, compared with14.81% of the control group, the difference was not statistically significant(P >0.05). Conclusion: Compared with propofol,dexmedetomidine can achieve better sedative, analgesic effects and reduce the incidence of delirium in patients with hip fracture surgery,there is no serious adverse reaction and high clinical value.
引文
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[23]Trivedi S,Kumar R,Tripathi AK,et al.A Comparative Study of Dexmedetomidine and Midazolam in Reducing Delirium Caused by Ketamine[J].J Clin Diagn Res,2016,10(8):UC01-UC04
[24]Mathews L,Camalier CR,Kla KM,et al.The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery:A Retrospective Analysis[J].Stereotact Funct Neurosurg,2017,95(1):40-48
[25]Yekta A,GümüF,Alagol A.Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach[J].Rev Bras Anestesiol,2015,65(5):371-378
[26]Zhao J,Zhou C.The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period[J].Exp Ther Med,2016,12(5):2903-2908
[27]Wei Y,Hu J,Liang Y,et al.Dexmedetomidine pretreatment attenuates propofol induced neurotoxicity in neuronal cultures from the rat hippocampus[J].Mol Med Rep,2016,14(4):3413-3420
[28]Hu SP,Zhao JJ,Wang WX,et al.Dexmedetomidine increases acetylation level of histone through ERK1/2 pathway in dopamine neuron[J].Hum Exp Toxicol,2017,36(5):474-482
[29]周兴,钟素平,雷亨发,等.右美托咪定联合舒芬太尼对下肢骨折手术患者术后镇痛效果及免疫功能的影响[J].中国医师进修杂志,2017,40(6):531-535
[30]Rapchuk IL,Glover P.Combined use of fascia iliaca block,subarachnoid block and dexmedetomidine sedation for patients having fractured femur surgery[J].J Anesth,2013,27(1):149-150
[2]Vrahas MS,Sax HC.Timing of Operations and Outcomes for Patients With Hip Fracture-It's Probably Not Worth the Wait[J].JAMA,2017,318(20):1981-1982
[3]Pesic G,Jeremic J,Nikolic T,et al.Interleukin-6 as possible early marker of stress response after femoral fracture[J].Mol Cell Biochem2017,430(1-2):191-199
[4]Li R,Fan L,Ma F,et al.Effect of etomidate on the oxidative stress response and levels of inflammatory factors from ischemiareperfusion injury after tibial fracture surgery[J].Exp Ther Med2017,13(3):971-975
[5]Zhao JN,Kong M,Qi B,et al.Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients:Aprospective,randomized,controlled clinical trial[J].Medicine(Baltimore),2016,95(33):e4576
[6]Peng K,Liu HY,Wu SR,et al.Effects of Combining Dexmedetomidine and Opioids for Postoperative Intravenous Patient-controlled Analgesia:A Systematic Review and Meta-analysis[J].Clin J Pain,2015,31(12):1097-1104
[7]Peleg K,Rozenfeld M,Israeli A.The danger of non-exhaustive quality measures:requiring hip fracture repair surgery within 48 hours-a case study[J].Isr J Health Policy Res,2017,6(1):64
[8]Suh YS,Won SH,Choi HS,et al.Survivorship and Complications after Hip Fracture Surgery in Patients with Chronic Kidney Disease[J].J Korean Med Sci,2017,32(12):2035-2041
[9]郭兴仁,丁允知,周勇,等.高龄髋部骨折患者手术前发生DVT的影响因素分析[J].现代生物医学进展,2016,16(34):6698-6702
[10]Li T,Yeung J,Li J,et al.Comparison of regional with general anaesthesia on postoperative delirium(RAGA-delirium)in the older patients undergoing hip fracture surgery:study protocol for a multicentre randomised controlled trial[J].BMJ Open,2017,7(10):e016937
[11]Neerland BE,Krogseth M,Julieb覬V,et al.Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients;A prospective follow-up study[J].PLoS One,201712(7):e0180641
[12]Shields L,Henderson V,Caslake R.Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture:ASystematic Review of Randomized Controlled Trials[J].J Am Geriatr Soc,2017,65(7):1559-1565
[13]Bong CL,Lim E,Allen JC,et al.A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging[J].Anaesthesia,2015,70(4):393-399
[14]Guo Y,Jia P,Zhang J,et al.Prevalence and risk factors of postoperative delirium in elderly hip fracture patients[J].J Int Med Res,2016,44(2):317-327
[15]Smith TO,Cooper A,Peryer G,et al.Factors predicting incidence of post-operative delirium in older people following hip fracture surgery a systematic review and meta-analysis[J].Int J Geriatr Psychiatry2017,32(4):386-396
[16]Liu L,Wu AP,Yang Y,et al.Effects of Propofol on Respiratory Drive and Patient-ventilator Synchrony during Pressure Support Ventilation in Postoperative Patients:A Prospective Study[J].Chin Med J(Engl),2017,130(10):1155-1160
[17]Hickel C.Early percutaneous pinning of hip fracture using propofol-ketamine-lidocaine admixture in a geriatric patient receiving dabigatran:a case report[J].AANA J,2014,82(1):46-52
[18]毛烨,赵晶,高玉凤,等.右美托咪啶和丙泊酚对老年髋部骨折术后重症患者镇静效果的比较[J].中华医学杂志,2015,95(19):1493-1495
[19]Konkayev AK,Bekmagambetova NV.Comparison of sedation with dexmedetomidine and haloperidol in patients with delirium after femoral neck fractures[J].Anesteziol Reanimatol,2015,60(1):8-11
[20]Ciftci T,Erbatur S,Ak M.Comparison of the effects of dexmedetomidine and remifentanil on potential extreme haemodynamic and respiratory response following mask ventilation and laryngoscopy in patients with mandibular fractures[J].Eur Rev Med Pharmacol Sci,2015,19(22):4427-4433
[21]Reade MC.Low dose dexmedetomidine for the prophylaxis of perioperative ICU delirium-how much evidence is enough?[J].JThorac Dis,2016,8(11):3020-3023
[22]Read MD,Maani CV,Blackwell S.Dexmedetomidine as a Rescue Therapy for Emergence Delirium in Adults:A Case Series[J].A ACase Rep,2017,9(1):20-23
[23]Trivedi S,Kumar R,Tripathi AK,et al.A Comparative Study of Dexmedetomidine and Midazolam in Reducing Delirium Caused by Ketamine[J].J Clin Diagn Res,2016,10(8):UC01-UC04
[24]Mathews L,Camalier CR,Kla KM,et al.The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery:A Retrospective Analysis[J].Stereotact Funct Neurosurg,2017,95(1):40-48
[25]Yekta A,GümüF,Alagol A.Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach[J].Rev Bras Anestesiol,2015,65(5):371-378
[26]Zhao J,Zhou C.The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period[J].Exp Ther Med,2016,12(5):2903-2908
[27]Wei Y,Hu J,Liang Y,et al.Dexmedetomidine pretreatment attenuates propofol induced neurotoxicity in neuronal cultures from the rat hippocampus[J].Mol Med Rep,2016,14(4):3413-3420
[28]Hu SP,Zhao JJ,Wang WX,et al.Dexmedetomidine increases acetylation level of histone through ERK1/2 pathway in dopamine neuron[J].Hum Exp Toxicol,2017,36(5):474-482
[29]周兴,钟素平,雷亨发,等.右美托咪定联合舒芬太尼对下肢骨折手术患者术后镇痛效果及免疫功能的影响[J].中国医师进修杂志,2017,40(6):531-535
[30]Rapchuk IL,Glover P.Combined use of fascia iliaca block,subarachnoid block and dexmedetomidine sedation for patients having fractured femur surgery[J].J Anesth,2013,27(1):149-150