氟哌啶醇对老年髋关节置换手术患者术后谵妄的影响
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摘要
目的观察氟哌啶醇对老年髋关节置换手术患者术后谵妄(POD)影响。方法择期行单侧髋关节置换手术患者60例,男34例,女26例,年龄65～85岁,ASAⅠ—Ⅲ级,随机分为氟哌啶醇组(H组)和对照组(C组)。两组麻醉方法相同,手术结束后均行PCIA,H组:舒芬太尼2μg/kg+氟比洛芬酯3 mg/kg+氟哌啶醇5 mg;C组:舒芬太尼2μg/kg+氟比洛芬酯3 mg/kg,均由生理盐水配制成100 ml,以2 ml/h的速度持续静脉泵注48 h。观察并记录术后1、6、12、24、36、48 h Ramsay镇静评分和VAS疼痛评分。记录术后第1～3晚睡眠质量评分。采用意识混乱评估法(CAM)评定POD。记录术后心动过缓或心动过速、嗜睡、恶心呕吐和锥体外系症状等不良反应的发生情况。结果与C组比较,H组术后6 h和12 h的Ramsay镇静评分明显升高(P<0.05),术后6 h和12 h的VAS疼痛评分明显降低(P<0.05),术后第1晚和第2晚睡眠质量评分明显降低(P<0.05)。H组有2例(6.7%)发生POD,明显少于C组的9例(30.0%)(P<0.05)。H组术后恶心呕吐发生率明显低于C组(P<0.05)。两组其他不良反应发生率差异无统计学意义。结论术后行PCIA中加入5 mg氟哌啶醇可以降低老年髋关节置换手术患者术后谵妄的发生率,且改善术后转归。
Objective To observe the effect of haloperidol on the incidence of postoperative delirium in elderly patients undergoing hip replacement surgery. Methods Sixty elderly patients scheduled for hip replacement surgery, 34 males and 26 females, aged 65-85 years, falling into ASA physical status Ⅰ-Ⅲ, were enrolled in this study. All the patients were randomly divided into two groups: haloperidol group(group H) and control group(group C) with 30 cases in each. They were given patient-controlled intravenous analgesia(PCIA) after operation. Group H: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg+ haloperidol 5 mg; group C: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg, All were added into sodium chloride injection to 100 ml, intravenous infusion was continued at the rate of 2 ml/h for 48 h.The value of Ramsay scores and VAS scores were recorded in 1, 6, 12, 24, 36 and 48 h after surgery. The quality of sleep was recorded on the 1 st to 3 rd night after surgery. The rate of postoperative delirium was evaluated by confusion assessment method(CAM). Also postoperative adverse effects(bradycardia, tachycardia, somnolence, nausea and vomiting and extrapyramidal symptoms) in the two groups were recorded. Results Compared with group C, the Ramsay scores of group H at 6 h and 12 h after surgery were significantly higher(P < 0.05). The VAS scores of group H decreased significantly at 6 h and 12 h after surgery(P < 0.05). The quality of sleep scores on the 1 st and 3 rd night were significantly lower than that in group C(P < 0.05). The incidence rate of postoperative delirium was significantly lower(6.7%) than that in group C(30.0%)(P < 0.05). The incidence rate of postoperative nausea and vomiting(PONV)was significantly lower(6.7%) than that in group C(26.7%)(P < 0.05). There was no significant difference of other adverse effects between the two groups. Conclusion Haloperidol 5 mg added to PCIA is effective in reducing the incidence rate of postoperative delirium in elderly patients undergoing hip replacement surgery and improving postoperative outcome.
Objective To observe the effect of haloperidol on the incidence of postoperative delirium in elderly patients undergoing hip replacement surgery. Methods Sixty elderly patients scheduled for hip replacement surgery, 34 males and 26 females, aged 65-85 years, falling into ASA physical status Ⅰ-Ⅲ, were enrolled in this study. All the patients were randomly divided into two groups: haloperidol group(group H) and control group(group C) with 30 cases in each. They were given patient-controlled intravenous analgesia(PCIA) after operation. Group H: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg+ haloperidol 5 mg; group C: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg, All were added into sodium chloride injection to 100 ml, intravenous infusion was continued at the rate of 2 ml/h for 48 h.The value of Ramsay scores and VAS scores were recorded in 1, 6, 12, 24, 36 and 48 h after surgery. The quality of sleep was recorded on the 1 st to 3 rd night after surgery. The rate of postoperative delirium was evaluated by confusion assessment method(CAM). Also postoperative adverse effects(bradycardia, tachycardia, somnolence, nausea and vomiting and extrapyramidal symptoms) in the two groups were recorded. Results Compared with group C, the Ramsay scores of group H at 6 h and 12 h after surgery were significantly higher(P < 0.05). The VAS scores of group H decreased significantly at 6 h and 12 h after surgery(P < 0.05). The quality of sleep scores on the 1 st and 3 rd night were significantly lower than that in group C(P < 0.05). The incidence rate of postoperative delirium was significantly lower(6.7%) than that in group C(30.0%)(P < 0.05). The incidence rate of postoperative nausea and vomiting(PONV)was significantly lower(6.7%) than that in group C(26.7%)(P < 0.05). There was no significant difference of other adverse effects between the two groups. Conclusion Haloperidol 5 mg added to PCIA is effective in reducing the incidence rate of postoperative delirium in elderly patients undergoing hip replacement surgery and improving postoperative outcome.
引文
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[13] Zhuo M.Ionotropic glutamate receptors contribute to pain transmission and chronic pain.Neuropharmacology,2017,112(Pt A):228-234.
[14] Porcelli S,Crisafulli C,Calabrò M,et al.Possible biomarkers modulating haloperidol efficacy and/or tolerability.Pharmacogenomics,2016,17(5):507-529.
[15] Slooff VD,van den Dungen DK,van Beusekom BS,et al.Monitoring haloperidol plasma concentration and associated adverse events in critically ill children with delirium:first results of a clinical protocol aimed to monitor efficacy and safety.Pediatr Crit Care Med,2018,19(2):e112-e119.
[2] Inouye SK,Westendorp RG,Saczynski JS.Delirium in elderly people.Lancet,2014,383(9920):911-922.
[3] Teslyar P,Stock VM,Wilk CM,et al.Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients:a meta-analysis.Psychosomatics,2013,54(2):124-31.
[4] Hempenius L,Slaets JP,van Asselt D,et al.Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients:report on a multicentre,randomized,controlled trial.PLoS One,2013,8(6):e64834.
[5] Li J,Zhou J,Wan Y,et al.Association between ABO blood type and postoperative cognitive dysfunction in elderly patients undergoing unilateral total hip arthroplasty surgery in China.Med Sci Monit,2017,23:2584-2589.
[6] Fan Y,Yuan L,Ji M,et al.The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty:a randomized controlled trial.J Clin Anesth,2017,39:77-81.
[7] Girard TD,Exline MC,Carson SS,et al.Haloperidol and ziprasidone for treatment of delirium in critical illness.N Engl J Med,2018,379(26):2506-2516.
[8] Barbateskovic M,Kraus SR,Collet MO,et al.Haloperidol for delirium in critically ill patients-protocol for a systematic review.Acta Anaesthesiol Scand,2018,62(5):712-723.
[9] Shen YZ,Peng K,Zhang J,et al.Effects of haloperidol on delirium in adult patients:a systematic review and meta-analysis.Med Princ Pract,2018,27(3):250-259.
[10] Milrad SF,Hall DL,Jutagir DR,et al.Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis(CFS/ME) symptoms in women.J Neuroimmunol,2017,303:43-50.
[11] Noorafshan A,Karimi F,Kamali AM,et al.Could curcumin protect the dendritic trees of the CA1 neurons from shortening and shedding induced by chronic sleep restriction in rats.Life Sci,2018,198:65-70.
[12] Fadayomi AB,Ibala R,Bilotta F,et al.A systematic review and meta-analysis examining the impact of sleep disturbance on postoperative delirium.Crit Care Med,2018,46(12):e1204-e1212.
[13] Zhuo M.Ionotropic glutamate receptors contribute to pain transmission and chronic pain.Neuropharmacology,2017,112(Pt A):228-234.
[14] Porcelli S,Crisafulli C,Calabrò M,et al.Possible biomarkers modulating haloperidol efficacy and/or tolerability.Pharmacogenomics,2016,17(5):507-529.
[15] Slooff VD,van den Dungen DK,van Beusekom BS,et al.Monitoring haloperidol plasma concentration and associated adverse events in critically ill children with delirium:first results of a clinical protocol aimed to monitor efficacy and safety.Pediatr Crit Care Med,2018,19(2):e112-e119.