国际麻醉学与复苏杂志   2016, Issue (3): 9-9
    
不同剂量右美托咪定对全麻下髋关节置换术老年高血压患者术后谵妄的影响
夏勇军, 张蓬勃, 赵侠勇1()
1.武警工程大学医院麻醉科
Effects of different dose of dexmedetomidine on postoperative deliriumin from general anaesthesia undergoing hip-replacement surgery in aged hypertensive patients
 全文:
摘要：

【摘要】目的 评价不同剂量右美托咪定（dexmedetomide,Dex）对全麻下老年高血压患者术后谵妄(postoperative delirium,POD)的影响。方法 选择择期行髋关节置换术老年高血压患者120例，年龄65～85岁，采用随机数字表法均分为：高剂量Dex组(D1组)、低剂量Dex组（D2组）和对照组（C组）。麻醉诱导前D1组、D2组分别泵注Dex 0.6ug/kg、0.2ug/kg负荷量，10min泵完，分别继续以0.4g•kg－1•h-1、0.2 g•kg－1•h-1维持至手术结束前30 min；C组泵注等量生理盐水。观察时间点为给药前（T0）、给药后10 min(T1) 、气管插管时(T2)、气管导管拔除时（T3）、术后第6h（T4）、术后24h（T5）、术后48h(T6)。记录T0、T1、T2、T3各时点的MAP和HR情况，于T0、T3、T4、T5、及T6时采集静脉血检测血糖（GLu）、皮质醇(Cor)和白介素-6(IL-6)的血浆浓度，采用谵妄分表-98修订版（DRS）评估T4～T6时患者POD的发生情况。结果 T2、T3时C组MAP[(135.2±12.5)mmHg和[(126.6±11.5)mmHg]、HR[(105.2±11.4)次/min 和(94.3±9.4)次/min]比T0时[(111.3±11.2)mmHg、（70.6±9.6）次/min]显著升高（P<0.05），T3～T5时C组GLu[(9.8±0.7)mmol/L,(9.6±0.4)mmolL,(10.6±0.6)mmol/L],Cor[(550.3±54.7)nmol/L,(465.9±58.6)nmol/L,(449.8±44.5)nmol/L],IL-6[(174.8±14.1)ng/ml,(115.0±10.1)ng/ml,(80.9±8.3)ng/ml]比T0时GLu[(4.2±0.4)mmol/L, Cor[(352.6±37.2)nmol/L, IL-6[(58.2±5.9)ng/ml显著升高（P<0.05）； T1～T3时D1组MAP[(89.6±10.2)mmHg],[(99.3±10.5)mmHg]，HR[(61.6±8.5)次/min],[(63.4±11.2)次/min]比C组MAP[(121.4±10.3)mmHg,[(135.2±12.5)mmHg],HR[(79.4±11.5)次/min,(105.2±11.4)次/min]明显降低(P<0.05),T3～T5时D1组Cor[(421.4±38.6)nmol/L,(344.9±34.8)nmol/L,(324.6±35.3)nmol/L]， IL-6[(81.8±11.3)ng/ml,(106.0±10.5)ng/ml,( 67.4±10.6)ng/ml]比D2组Cor[(466.0±43.2)nmol/L，(398.9±36.5)nmol/L,(368.6±41.8)nmol/L],IL-6[(103.8±12.1)ng/ml,(136.4±13.9)ng/ml,(92.7±11.4)ng/ml]明显降低（P<0.05）；与C组相比，D1组、D2组POD的发生率明显降低，与D2组比较，D1组POD发生率明显降低（P<0.05）。结论 持续泵注不同剂量Dex均能维持血流动力学稳定，减少POD的发生，高剂量泵注Dex对POD的防治更有效，其机制可能与其减轻应激反应及抑制炎症反应水平有关。
关键词： 右美托咪定；高血压；应激；术后谵妄；老年
Abstract:

【Abstract】 Objective To evaluate the Effects of different dose of dexmedetomidine on the incidence of postoperative deliriumin from general anaesthesia in aged hypertensive patients. Methods A total 0f 120 patients with aged 65-85 years, undergoing hip-replacement surgery were randomly divided into 3 groups: high dexmedetomidine group(group D1), Low dexmedetomidine group(group D2) and Control group(group C) with 40 cases each. Dexmedetomidine were givened with o.6ug/kg within 10 min before anesthesia induction and followed with 0.4g•kg－1•h-1 in group D1, dexmedetomidine were givened with o.2ug/kg within 10 min before anesthesia induction and followed with 0.2g•kg－1•h-1 in grouop D2, The equal volume of normal saline was infused in group C. The observation time point is before dexmedetomidine infusion (T0), 10min after dexmedetomidine infusion(T1), immediately after intubation(T2), tracheal extubation (T3), immediately after the first 6h (T4), 24h after operation (T5), 48h after operation (T6). The plasma of Blood glucose,cortisol and interleukin 6 were detected at T0,T3,T4,T5 and T6.The rate of postoperative delirium was evaluated by delirium rating scale at the time T4,T5 andT6. Results MAP[(135.2±12.5)mmHgand(126.6±11.5)mmHg]andHR[(105.2±11.4)bpm and(94.3±9.4)bpm] were significantly higher at T2 and T3 than T0 in group C(P<0.05), while Cor[(550.3±54.7)nmol/L,(465.9±58.6)nmol/L,(449.8±44.5)nmol/L]andIL-6[(174.8±14.1)ng/ml,(115.0±10.1)ng/ml,(80.9±8.3)ng/ml] were significantly higher at T3-T5 than T0 in group C(P<0.05). Compared with group CMAP[(89.6±10.2)mmHg],[(99.3±10.5)mmHg] and HR[(61.6±8.5)bpm,(63.4±11.2)bpm]weredecreasedat T1～T3 in group D1 and group D2(P<0.05), while Cor[(550.3±54.7)nmol/L,(465.9±58.6)nmol/L,(449.8±44.5)nmol/L],andIL-6[(174.8±14.1)ng/ml,(115.0±10.1)ng/ml,(80.9±8.3)ng/ml] at T3-T5 were significantly decreased in group D1 and group D2(P<0.05). The incidence rate of delirium rating scale in group D1and group D2 was obviously lower than that in group C at T3-T6(P<0.05), Compared with group D2, The incidence rate of delirium rating scale were decreased at T3-T6 in group D1(P<0.05), Conclusions in the general anesthesia period, continuous application of dexmedetomidine can effectively maintain the stability of hemodynamics, can reduce the incidence rate of postoperative delirium in elderly hypertensive patients undergoing hip replacement surgery.High dosage dexmedetomidine showed an obvious effect on postoperative delirium. the mechanism maybe live in the effects of dexmedetomidine on the alleviation of stress in jury and inflammation
Key words: Dexmedetomidine；Hypertension；Stress；Postoperative deliriumin; Elderly