摘要
目的:探讨全凭静脉麻醉下应用右美托咪啶和亚麻醉剂量氯胺酮后老年骨科患者术后谵妄的发生情况,阐明右美托咪啶和亚麻醉剂量氯胺酮对老年骨科全麻患者术后谵妄发生率的影响。方法:选择全凭静脉麻醉下择期行骨科手术患者120例,ASA分级Ⅰ～Ⅲ级,年龄>60岁,采用随机数字表法随机分为对照组、氯胺酮组、右美托咪啶组及氯胺酮+右美托咪啶组(均n=30)。麻醉前,氯胺酮组给予氯胺酮0.5mg.kg-1静脉注射;右美托咪啶组给予右美托咪啶1μg.kg-1静脉注射,随后以0.5μg.kg-1.h-1的速度输注右美托咪啶至术毕前30min;氯胺酮+右美托咪啶组给予氯胺酮0.5mg.kg-1静脉注射和右美托咪啶1μg.kg-1静脉注射,随后以0.5μg.kg-1.h-1的速度输注右美托咪啶至术毕前30min;对照组静脉输注等量的生理盐水。于麻醉前、手术结束后、术后24h分别采集静脉血,采用双抗体夹心ELISA法测定血清白细胞介素6(IL-6)水平。根据谵妄评定法(CAM),分别于术后1h、1d及3d3个时间点评定患者是否发生谵妄,并对各组患者清醒时间进行比较。结果:4组患者的一般情况比较差异无统计学意义(P>0.05)。本研究共有13例患者发生谵妄:氯胺酮组8例(26.7%),右美托咪啶组2例(6.7%),对照组3例(10%),氯胺酮+右美托咪啶组患者均未发生谵妄。与对照组比较,氯胺酮组患者术后谵妄发生率显著增加(P<0.05);与氯胺酮组比较,氯胺酮+右美托咪啶组患者术后谵妄发生率显著降低(P<0.05);各组患者血清IL-6水平比较差异无统计学意义(P>0.05)。与对照组比较,右美托咪啶组患者睁眼至拔管时间显著延长(P<0.05)。结论:全麻术中右美托咪啶与氯胺酮合用能减轻氯胺酮对患者的影响,减少术后谵妄的发生,其机制与炎症反应无关。
Objective To investigate the incidence of postoperative delirium after using dexmedetomidine and sub- anesthetic dose of ketamine and to clarify their influence in the incidence of postoperative delirium in elderly orthopedic patients under total intravenous anesthesia. Methods One hundred and twenty elderly patients aged more than 60 years underwent elective orthopedic surgery, ASA I -HI, were randomly divided into 4 groups （n= 30）： normal saline （control group）, ketamine group, dexmedetomidine group, ketamine-F dexmedetomidine group. The patients in ketamine group received an intravenous injection of ketamine at a dosage of 0.5 mg kg-1. In dexmedetomidine group the patients received dexmedetomidine at a dosage of 1 μg kg i by intravenous injection before induction of anesthesia followed by a continuous infusion at 0.5 μg kg-1 h-1 till 30 min before the end of operation. In ketamine--k dexmedetomidine group, the patients received both 0.5 mg kg-1 ketamine and 1.0 μg kg-1 dexmedetomidine over 10 min by introvenous injection followed by a continuous infusion of dexmedetomidine at 0.5μg kg-1 h-1 till 30 min before the end of operation. The patients in control group were administered with the same amount of normal saline. The blood samples were taken before anesthesia, at the end of operation and 24 h after operation. The level of serum interleukin-6 （IL-6） was detected using enzyme-linked immunosorbent assay （ELISA）. The Confusion Assessment Method （CAM） was applied to evaluate postoperative delirium 1 h, 1 d and 3 d after operation. Results There were no statistical significance in age, gender, weight, operation time, anesthesia time, anesthesia dosage, bleeding, urine volume and infusion of the patients between four groups （P〈0.05）. 13 patients in the study developed delirium.. 8 patients in ketamine group （26.7%）, 2 patients in dexmedetomidine group （6.7%）, 3 patients in control group （10%）; no delirium was found in ketamine-t-dexmedetomidine group. Compared with control group, the incidence rate of delirium in ketamine group was increased significantly （P〈0.05）. Compared with ketamine group, the incidence rate of delirium in ketamineq- dexmedetomidine group was decreased significantly （P〈0.05）. There was no significant difference in serum IL-6 levels of patients between four groups （P〈0. 05）.Conclusion When they are applied together, dexmedetomidine could alleviate the side effects of ketamine and could decrease the incidence rate of delirium which mechanism is not responsible with inflammation.
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2013年第1期128-132,共5页
Journal of Jilin University：Medicine Edition
基金
国家自然科学基金资助课题(81141065)
关键词
右美托咪啶
氯胺酮
白细胞介素6
麻醉
全身
术后谵妄
老年
dexmedetomidine
ketamine
interleukin-6
anesthesia, general
postoperative delirium
elderly
