贵州医科大学学报

2018, v.43;No.212(05) 572-576

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右美托咪定对全身麻醉老年患者骨科术后机械痛阈值、认知功能及苏醒期躁动的影响
Effect of Dexmedetomidine on Postoperative Mechanical Pain Threshold,Cognitive Function and Emergence Agitation in Elderly Patients Undergoing Orthopedic Surgery under General Anesthesia

何加宁;
HE Jianing;Department of Pain Management,Sports Hospital Affiliated to Chengdu Institute of P.E.;

摘要(Abstract):

目的:探讨右美托咪定对全身麻醉下老年骨科手术患者术后机械痛阈值、认知功能及苏醒期躁动的影响。方法:84例行全身麻醉下骨科手术老年患者均分为对照组与观察组,均采用常规全身麻醉,观察组切皮前10 min经静脉输注右美托咪定0.5μg/kg,对照组输注等容量0.9%氯化钠溶液,记录2组患者麻醉诱导前(T_0)、拔管时(T_1)、拔管后5 min(T_2)、拔管后10 min(T_3)时的心率(HR)、收缩压(SBP)及舒张压(DBP);统计2组患者自主呼吸恢复时间、苏醒时间和拔管时间并监测2组患者术前、术后6、12、24及48 h时患者的机械痛觉阈值;采用Riker镇静躁动评分测定患者拔管时及拔管后5 min的苏醒期镇静及躁动情况;采用简易智能量表(MMSE)评定术前、术后第1天及第3天时患者手术认知功能的变化。结果:2组患者T_1~T_3点的HR、SBP、DBP高于同组T_0时点,观察组T_1~T_3时点的HR、SBP、DBP均低于同时点对照组(P<0.05);两组自主呼吸恢复时间、拔管时间、苏醒时间比较,差异无统计学意义(P>0.05);术后6、12、24及48 h时,2组患者机械痛觉阈值降低,观察组术后不同时间机械痛觉阈值均高于同时间点对照组(P<0.05);两组患者T_2时点Riker镇静躁动评分均较T_1时点降低,观察组T_1、T_2时点时镇静躁动评分均低于同时间点对照组(P<0.05);观察组术后第1天及第3天时MMSE评分均高于同时点对照组(P<0.05);观察组患者苏醒期躁动发生率、术后早期认知功能障碍发生率低于对照组(P<0.05)。结论:右美托咪定可降低全身麻醉下老年骨科手术患者苏醒期并发症发生率,提高患者术后机械痛阈值,降低认知功能障碍发生风险。
Objective: To explore the effect of dexmedetomidine on postoperative mechanical pain threshold,cognitive function and emergence agitation in elderly patients who underwent orthopedic surgery under general anesthesia. Methods: 84 cases of elderly patients who underwent orthopedic surgery under general anesthesia were equally divided into the control group and the observation group.Both groups were given routine general anesthesia. The observation group was given intravenous infusion of 0. 5 μg/kg dexmedetomidine in 10 min before skin incision,while the control group was infused with equal volume of 0. 9% sodium chloride solution. The heart rate( HR),systolic blood pressure( SBP) and diastolic blood pressure( DBP) were recorded before anesthesia induction( T0),at extubation( T1),in 5 min after extubation( T2) and in 10 min after extubation( T3). The spontaneous respiration recovery time,analepsia time and extubation time of both groups were statistically analyzed.The mechanical pain thresholds of both groups were monitored before operation,in 6 h,12 h,24 h and 48 h after operation. The situation of sedation and agitation was evaluated with Riker sedation and agitation scores at T1 and T2. Changes of cognitive function before operation and in the 1~(st)and 3~(rd)days after operation were evaluated with the mini-mental state examination( MMSE). Results: HR,SBP and DBP at T1 ~ T3 were higher than those at T0 in both groups,and were lower in the observation group than in the control group at the same time( P < 0. 05). There was no significant difference in the spontaneous breathing recovery time,extubation time or analepsia time between the two groups( P> 0. 05). In 6 h,12 h,24 h and 48 h after operation,the mechanical pain threshold decreased in both groups( P < 0. 05). They were higher in the observation group than in the control group at the same time point after operation( P < 0. 05). At T2,the Riker sedation and agitation scores decreased in both groups( P < 0. 05). The scores of the observation group at T1 and T2 were lower than those of the control group at the same time( P < 0. 05). The MMSE scores of the observation group on the 1~(st) and 3~(rd)days after operation were higher than those of the control group at the same time point( P <0. 05). The incidence rates of emergence agitation and early postoperative cognitive dysfunction in the observation group were lower than those in the control group( P < 0. 05). Conclusions: Dexmedetomidine can reduce the incidence rate of postoperative complications in elderly patients undergoing orthopedic surgery under general anesthesia. It can improve the postoperative mechanical pain threshold and reduce the risk of cognitive dysfunction.

关键词(KeyWords): 骨科手术;右美托咪定;全身麻醉;苏醒期躁动;认知功能
orthopedic surgery;dexmedetomidine;general anesthesia;emergence agitation;cognitive function

Abstract:

Keywords:

基金项目(Foundation): 四川省卫生厅科研课题(1303231)

作者(Author): 何加宁;
HE Jianing;Department of Pain Management,Sports Hospital Affiliated to Chengdu Institute of P.E.;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.05.016

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