文章摘要
宋 芬,刘 玥,殷霞丽,刘晓杰,吴 浩,董媛媛.右美托咪定辅助麻醉对老年腹部重症病患术后谵妄以及Ramsay镇静评分的影响[J].,2020,(12):2275-2279
右美托咪定辅助麻醉对老年腹部重症病患术后谵妄以及Ramsay镇静评分的影响
Effects of Dexmedetomidine Assisted Anesthesia on Postoperative Delirium and Ramsay Sedation Score in Elderly Patients with Severe Abdominal Disease
投稿时间:2020-01-19  修订日期:2020-02-13
DOI:10.13241/j.cnki.pmb.2020.12.015
中文关键词: 右美托咪定  老年腹部重症  术后谵妄  Ramsay镇静评分
英文关键词: Dexmedetomidine  Elderly abdominal severe  Postoperative delirium  Ramsay sedation score
基金项目:国家自然科学基金项目(81771142);江苏省第十六批"六大人才高峰"高层次人才选拔培养项目(YY-084)
作者单位E-mail
宋 芬 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000 13951086826@139.com 
刘 玥 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000  
殷霞丽 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000  
刘晓杰 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000  
吴 浩 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000  
董媛媛 南京大学医学院附属鼓楼医院麻醉科 江苏 南京 210000  
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中文摘要:
      摘要 目的:探讨右美托咪定辅助麻醉对老年腹部重症病患术后谵妄以及Ramsay镇静评分的影响。方法:将2018年6月-2019年6月我院收治入院的48例拟行手术的老年腹部重症患者为研究对象,随机分为观察组和对照组各24例,分别给予负荷剂量1 μg/kg右美托咪定和等量盐水注入。术中观察组继续泵入右美托咪定0.2 μg/(kg?h),对照组输注等量生理盐水。记录不同时间段神经元特异性烯醇化酶(NSE)、血清S100β蛋白、白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)的浓度,拔管时间,苏醒时间,术后1、2、3d谵妄发生情况及术后不同时间段的Ramsay镇静评分。结果:T0时,两组NSE、血清S100蛋白、TNF-α及IL-1β的浓度比较,差异均无统计学意义(P>0.05);T1-T3时,两组NSE、血清S100蛋白、TNF-α及IL-1β的浓度持续升高,且观察组NSE、血清S100蛋白、TNF-α及IL-1β的浓度均低于对照组,差异均有统计学意义(P<0.05);T4时,两组均显著下降,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者拔管时间及苏醒时间均短于对照组,差异均有统计学意义(P<0.05)。观察组患者在术后谵妄总发生率少于对照组,差异有统计学意义(P<0.05)。与术后30 min时相比,两组术后1 h、6 h、12 h、24 h、48 h时均显著降低,且观察组在术后30 min、1 h、6 h、12 h、24 h、48 h均低于对照组,差异均有统计学意义(P<0.05)。结论:右美托咪定辅助麻醉应用于老年腹部重症患者,可保持患者心率及平均动脉压平稳,缩短拔管时间及苏醒时间,减少术后谵妄发生情况,且缩短谵妄发生时间,值得临床推广普及。
英文摘要:
      ABSTRACT Objective: To investigate the effect of dexmedetomidine assisted anesthesia on postoperative delirium and Ramsay sedation score in elderly patients with severe abdominal disease. Methods: A total of 48 elderly patients with severe abdominal diseases who were admitted to our hospital from June 2018 to June 2019 for the study were randomly divided into the observation group and the control group,with 24 patients in each group. The loading dose of 1 μg/kg dexmedetomidine and the same amount of saline were given respectively,and during the operation, the observation group continued to pump dexmedetomidine 0.2 μg/(kg?h), and the control group was injected with the same amount of normal saline. The concentrations of neuron-specific enolase (NSE), serum S100 protein,Interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α), extubation time, recovery time, postoperative 1, 2, 3d delirium, and Ramsay sedation score at different time periods were recorded. Results: At T0, the concentrations of NSE, serum S100 protein, TNF-α and IL-1β in the two groups had no statistical significance (P>0.05); at T1-T3, the concentrations of NSE, serum S100 protein, TNF-α and IL-1β in the two groups continued to rise, and the concentrations of NSE, serum S100 protein, TNF-α and IL-1β in the observation group were lower than those in the control group, with statistical significance (P<0.05); at T4, the two groups were significantly reduced, and the observation group was lower than the control group, the difference was statistically significant (P<0.05). The extubation time and recovery time of the patients in the observation group were shorter than those in the control group (P<0.05). The total incidence of postoperative delirium in the observation group was lower than that in the control group,the difference was statistically significant (P<0.05). Compared with postoperative 30 min, the two groups were significantly lower at postoperative1 h, 6 h, 12 h, 24 h and 48 h, and the observation group was lower than the control group at postoperative 30 min, 1 h, 6 h, 12 h, 24 h and 48 h, the difference was statistically significant(P<0.05). Conclusion: The application of dexmedetomidine assisted anesthesia in the elderly patients with severe abdominal diseases can keep the heart rate and average arterial pressure stable, shorten the time of extubation and recovery, reduce the incidence of postoperative delirium, and shorten the time of delirium, which is worthy of clinical popularization.
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