不同剂量右美托咪定复合七氟醚对老年髋关节置换术后.docVIP

不同剂量右美托咪定复合七氟醚对老年髋关节置换术后 　　【摘要】 目的 探讨不同剂量右美托咪定复合七氟醚对老年髋关节置换术后认知功能的影响。方法 75例老年髋关节置换术患者随机分为对照组和不同剂量右美托咪定组（A0、A1、A2、A3组）， 每组15例。右美托咪定组采用右美托咪定负荷剂量0.8 μg/kg， 以A0、A1、A2、A3组分别为0、0.2、0.4、0.6 μg/（kg?h）的速率持续输注， 对照组患者采用等容量生理盐水。比较各组的麻醉效果。结果 A2、A3组患者的自主呼吸恢复时间、呼之睁眼时间显著长于其他组患者（P0.05）；对照组术中七氟醚平均浓度高于其他组（P0.05）；术后第1天A1、A2、A3组患者简易智力状态检查量表（MMSE）得分显著高于其他组患者（P0.05）；A1、A2、A3组患者的术后认知功能障碍（POCD）发生率显著低于其他组患者（P0.05）。结论 右美托咪定负荷剂量0.8 μg/kg静脉输注后持续0.2 μg/（kg?h）复合七氟醚麻醉， 能让老年髋关节置换术后早期认知功能障碍发生率降低， 安全可靠。 　　【关键词】 不同剂量；右美托咪定；七氟醚；老年；髋关节置换术；认知功能 　　【Abstract】 Objective To investigate influence by different doses of dexmedetomidine combined with sevoflurane on cognitive function after senile hip replacement. Methods A total of 75 senile hip replacement patients were randomly divided into control group and different-dose dexmedetomidine groups （groups A0， A1， A2， A3）， with 15 cases in each group. Dexmedetomidine groups received 0.8 μg/kg dexmedetomidine as load dosage， and groups A0， A1， A2， A3 received continuous infusion by 0， 0.2， 0.4， 0.6 μg/（kg?h）. Control group received normal saline by the same dosage. Anesthetic effects of all groups were compared. Results Groups A2 and A3 had obviously longer autonomous respiration recovery time and eye opening time than the other groups （P0.05）. Intraoperative mean concentration of sevoflurane was higher in the control group than in other groups （P0.05）. Groups A1， A2， and A3 had much higher mini-mental state examination （MMSE） scores than the other groups （P0.05）， and they had much lower incidence of postoperative cognitive dysfunction （POCD） than the other groups （P0.05）. Conclusion Anesthesia by 0.2 μg/（kg?h） of continuous dexmedetomidine after 0.8 μg/kg as load dosage combined with sevoflurane can reduce incidence of early postoperative cognitive dysfunction after senile hip replacement with safety and reliability. 　　【Key words】 Different doses； Dexmedetomidine； Sevoflurane； Senile； Hip replacement； Cognitive function 　　近年来研究表明， 60岁以上患者在接受关节置换等外科手术后， 常