张晓伟 张敏 项明琼 郭旋

摘要：目的  探討小剂量右美托咪定对老年患者膝关节置换术后谵妄的防治效果。方法  选择2019年1～12月我院择期行膝关节置换术的老年患者118例，按随机数字表法分为实验组和对照组，每组59例。实验组行脊麻前10 min静脉泵注右美托咪定负荷量0.5 μg/kg，后以0.2 μg/（kg·h）的速度持续静脉泵注至术毕，对照组无静脉复合用药，比较两组麻醉效果、术后疼痛评分、MMSE评分、POD发生率及并发症发生率。结果  两组椎管内麻醉效果优良率比较，差异无统计学意义（P>0.05）;两组T0时点MAP、HR比较，差异无统计学意义（P>0.05）;实验组T1、T2时点MAP、HR低于对照组，差异有统计学意义（P<0.05）;实验组术后第2天MMSE评分高于对照组[（26.21±1.51）分 vs（24.31±1.42）分]，差异有统计学意义（P<0.05）。实验组POD发生率低于对照组（3.39% vs 15.25%），差异有统计学意义（P<0.05）。结论  在老年患者膝关节置换术中静脉复合小剂量右美托咪定可保护患者认知功能，降低术后谵妄的发生率，促进患者术后康复，可能是较好的术后谵妄干预措施。

关键词：右美托咪定;膝关节置换术;术后谵妄

中图分类号：R614                                  文献标识码：A                                  DOI：10.3969/j.issn.1006-1959.2020.15.047

文章编号：1006-1959（2020）15-0148-03

Abstract：Objective  To investigate the effect of low-dose dexmedetomidine on the prevention and treatment of delirium after knee arthroplasty in elderly patients.Methods  A total of 118 elderly patients who underwent elective knee arthroplasty in our hospital from January to December 2019 were divided into experimental group and control group according to the random number table method， with 59 cases in each group. The experimental group received intravenous pump injection of dexmedetomidine with a loading amount of 0.5 μg/kg 10 min before spinal anesthesia， and then continued intravenous pump injection at a rate of 0.2 μg/（kg·h） until the end of the operation. The control group had no intravenous compound medication. The anesthesia effect， postoperative pain score， MMSE score， POD incidence and complication incidence were compared between the two groups.Results  There was no statistically significant difference in the excellent and good rate of intraspinal anesthesia between the two groups （P>0.05）; the comparison of MAP and HR at T0 between the two groups was not statistically significant （P>0.05）; the experimental group at T1， T2 MAP and HR were lower than the control group， the difference was statistically significant （P<0.05）; the MMSE score of the experimental group was higher than the control group on the second day after surgery [（26.21±1.51） points vs （24.31±1.42） points]， the difference was statistically significant （P<0.05）. The incidence of POD in the experimental group was lower than that in the control group （3.39% vs 15.25%）， the difference was statistically significant （P<0.05）.Conclusion  In elderly patients with knee arthroplasty， intravenous combined low-dose dexmedetomidine can protect patients' cognitive function， reduce the incidence of postoperative delirium， and promote postoperative recovery. It may be a better intervention for postoperative delirium.

Key words：Dexmedetomidine;Knee replacement surgery;Postoperative delirium

随着我国人口老龄化问题日益严重，老年人膝关节退行性病变导致的膝关节炎患者也日益增多，膝关节炎带来的疼痛、活动受限严重影响老年患者生活質量。目前，膝关节置换术是治疗膝关节病变的有效方法，但手术给机体带来的创伤较大，导致术后强烈的应激反应，特别是老年患者，身体机能下降，应急能力下降，术后谵妄（POD）多发，严重影响老年患者术后康复及生存质量[1]。右美托咪定是一种高选择性α2肾上腺素能受体激动剂，通过激动分布于人体突触前膜的α2-AR，产生镇静、镇痛和抗焦虑作用，且无明显呼吸抑制[2]。有研究表明[3]，使用右美托咪定对POD有防治效果。本研究结合2019年1～12月我院择期行半膝关节置换术的118例老年患者的临床资料，探讨静脉复合小剂量右美托咪定对老年患者膝关节置换术后POD的防治效果，现报道如下。