摘要
目的探讨咪达唑仑、丙泊酚、右美托咪定麻醉对髋关节置换术老年患者术后认知功能障碍的影响。方法选取2015年6月～2016年2月我院确诊治疗的髋关节置换术老年患者120例，依据随机分配原则分为唑仑泊酚组和三药联合组，每组60例，唑仑泊酚组患者给予2mg／kg丙泊酚和0．5mg/kg咪达唑仑静脉滴注麻醉治疗，三药联合组患者在此麻醉前静脉泵注0．5μg／kg右美托咪定10min，采用简易智力状态检查量表（MMSE）评估认知功能障碍程度，统计分析所有患者术前（T0）、插管时（T1）、拔管时（T2）、缝合时（T3）的心率（HR），术前、术后1、4、7d认知功能和谵妄、不良反应发生情况。结果三药联合组患者T1、T2、T3时刻的HR明显低于唑仑泊酚组，差异有统计学意义（P〈0．05）；三药联合组患者术后1、4、7d的MMSE得分明显高于唑仑泊酚组，前者谵妄发生率明显低于后者，差异有统计学意义（P〈0．05）；唑仑泊酚组和三药联合组患者不良反应发生率基本相同，差异无统计学意义（P〉0．05）。结论咪达唑仑、丙泊酚、右美托咪定联合麻醉可有效减轻髋关节置换术老年患者术中的应激反应，改善患者术后认知功能障碍和降低谵妄的发生，且无增加患者术后不良反应发生的风险，值得临床作进一步推广。
Objective To explore the influence of midazolam, propofol and dexmedetomidine anesthesia to postoperative cognitive dysfunction of elderly patients with hip arthroplasty. Methods 120 cases of elderly patients with hip arthroplasty cured in our hospital from June 2015 to February 2016 were selected and randomly divided into midazolam group and three drug combination group with 60 cases in each. Patients in midazolam group were treated with 2mg/kg propofol and 0.Smg/kg midazolam intravenous infusion, and patients in three drug combination group were treated with 0.5g/kg dexmedetomidine intravenous infusion for 10min. Mini mental state examination scale （MMSE） was used to assess the degree of cognitive impairment. Heart rate （HR） on preoperative （T0）, intubation （T1）, extubation （T2） and suture time （T3）, cognitive function and delirium, the incidence of adverse reactions on 1, 4, 7 d before and after operation were statistically analyzed. Results Heart rate （HR） on preoperative （T0）, intubation （T1）, extubation （T2） and suture time （T3） of three drug combination group were significantly lower than those of midazolam group, and the differences were statistically significant （P 〈 0.05）. MMSE score on 1, 4, 7 d after operation of three drug combination group were significantly higher than that of midazolam group. The incidence of delirium of three drug combination group were significantly lower than that of midazolam group, and the difference was statistically significant （P 〈 0.05）. There were no significant differences on incidence of adverse reactions of the two groups （P 〉 0.05）. Conclusion Midazolam, propofol and dexmedetomidine anesthesia can effectively reduce the stress reaction in the elderly patients with hip replacement, improve the postoperative cognitive dysfunction and reduce the occurrence of delirium. And there is no increase in the risk of adverse reactions after operation. It is worthy of further clinical promotion.
出处
《中国医药科学》
2016年第15期152-155,共4页
China Medicine And Pharmacy
基金
广东省佛山市顺德区医学科研立项(2015A010)
