作　　者： (郭正轩）;

机构地区： 安阳地区医院麻醉科,河南安阳455000

出　　处： 《四川生理科学杂志》 2017年第3期133-134,共2页

摘　　要： 目的:观察右美托咪定对老年患者在腰硬联合麻醉下全髋关节置换手术后认知功能的影响。方法:选择我院2013年3月~2015年2月择期在腰硬联合麻醉下行全髋关节置换手术的高龄患者90例,年龄65~92岁,ASA Ⅱ~Ⅲ级,随机分为3组,即右美托咪定组(Dexmedetomidine hydrochloride injection,D组)、咪达唑仑组(Midazolam,M组)与生理盐水组(C组),每组30例。D组给予右美托咪定0.6μg·kg^(-1),持续15min,后以0.2~0.5μg·kg^(-1),持续泵注;M组给予咪达唑仑0.04 mg·kg^(-1),15min后以0.04mg·kg^(-1)持续泵注;C组泵注等量生理盐水。应用简易精神状态表记录患者术前1天、术后3天MMSE(Manmachine system engineering)评分,并记录发生术后认知功能障碍(Post operative cognitive dysfunction,POCD)的例数。结果:术后3天D组MMSE评分明显高于M组与C组(P<0.05)。M组中发生POCD8例,C组中发生POCD7例,D组中发生POCD2例。结论:老年患者在腰硬联合麻醉下全髋关节置换手术应用右美托咪定持续泵注可明显减少POCD的发生。 Objective：To observe the effects of dexmedetomidine on cognitive function in elderly patients undergoing surgery under combined spinal epidural anesthesia after total hip replacement.Methods：Ninety cases of elderly patients admitted in our hospital from March 2013 to 2015 were selected.All patients underwent total hip replacement surgery under combined spinal epidural anesthesia,the patient age is 65~92 years old,ASA Ⅱ~Ⅲ level.The patients were randomly divided into 3 groups,namely dexmedetomidine group（Dexmedetomidine hydrochloride injection group,D group）,midazolam group（M group）and saline group（C group）,30 cases in each group.D group received dexmedetomidine 0.6 μg·kg^（-1）,for 15 min,with 0.2~0.5 μg·kg^（-1）,continuous infusion.M group was given midazolam 0.04 mg·kg^（-1）,15 minutes later with 0.04 mg·kg^（-1）,continuous pump.The C group was injected with the same amount of normal saline.The MMSE（Man-machine system engineering）score was recorded 1 days before operation and on the 3 day after operation,and the cases of post operative cognitive dysfunction were recorded.Results：After 3 days,the MMSE score in group D was significantly higher than that in group C（P〈0.05）POCD occurred in eight cases of M group,7 cases of C group,and 2 cases of D group.Conclusion：Elderly patients with lumbar epidural anesthesia for total hip replacement surgery under the application of dexmedetomidine infusion can significantly reduce the incidence of POCD.

关 键 词： 右美托咪定 全髋关节置换 腰硬联合 认知功能障碍