亚麻醉剂量氯胺酮与右美托咪啶对老年骨科全麻患者术后谵妄发生率的影响

邓辉铃 刘炯峰

【摘要】目的研究亚麻醉剂量氯胺酮与右美托咪啶对老年骨科全麻患者术后谵妄发生率的影响。

方法选择2011年4月～2014年4月使用静脉麻醉的骨科手术患者130例，按随机数字表法分为观察组（65例）和对照组（65例）。麻醉前对照组患者静脉注射0.5 mg·kg-1的氯胺酮。观察组在对照组的基础上，静脉注射1 μg·kg-1的右美托咪啶，且在手术过程中以0.5 μg·kg-1的速率注射右美托咪啶。采用ELISA法分别于麻醉前、手术结束后及手术结束后1天测定患者血清IL6，观察患者麻醉结束至清醒睁眼（T1）、清醒至拔管（T2）、拔管至出室（T3）三个时段的时间，应用术后认知功能障碍（POCD）评价标准观察术后谵妄发生情况。

结果观察组麻醉前、手术后及手术后1天血清IL6水平与对照组相比差异均无统计学意义（P>005），观察组患者术后1天、3天谵妄发生率均显著低于对照组，差异有统计学意义（P<001）。两组T1、T3对比差异无统计学意义（P>0.05），

观察组T2显著短于对照组（P<001）。

结论 亚麻醉剂量氯胺酮联合右美托咪啶能显著降低老年骨科全麻患者术后谵妄发生率，且其机制与炎症反应并无关联。

【关键词】右美托咪啶；氯胺酮；亚麻醉剂量；谵妄

中图分类号：R614.24文献标识码：ADOI：10.3969/j.issn.10031383.2014.05.022

【Abstract】ObjectiveTo study the subanesthestic dosage of ketamine combined with dexmedetomidine on postoperative delirium incidence of elderly orthopaedic patients with general anesthesia.

Methods130 cases undergoing orthopedic surgery under intravenous anesthesia from April，2011 to April，2014 were randomly divided into observation group and control group with 65 cases in each group.Before anesthesia，the control group were given 0.5 mg/kg of ketamine by intravenous injection，based on which，the observation group were added with 1 μg·kg-1 of dexmedetomidine by intravenous injection.Besides，the dexmedetomidine was injected with a rate of 0.5 μg·kg-1 during the operation in the observation group.ELISA was used to test patients serum IL6 before anesthesia，after surgery and one day later after surgery，respectively.The time from finishing anesthesia to patients sobering and opening their eyes（T1），from sobering to tube drawing（T2） and from sobering to leaveing the operating room（T3）were observed.Evaluation criterion of postoperative cognitive dysfunction（POCD）was used to observe the occurrence of postoperative delirium.

Results No significant statistical difference was found in the serum IL6 before anesthesia，after surgery and one day of the two groups（P>0.05）.Delirium incidence one day later and three days later after surgery in the observation group was significantly lower than that of the control group，so the difference was statistically significant（P<001）.Difference of T1 and T3 in both groups was not statistically significant（P>0.05），but T2 of the observation group was obviously shorter than that of control group（P<001）.

ConclusionSubanesthestic dosage of ketamine combined with dexmedetomidine can significantly reduce the incidence of postoperative delirium of elderly orthopaedic patients with general anesthesia，and its mechanism is irrelevant to inflammatory reaction.

【Key words】dexmedetomidine；ketamine；subanesthestic dosage；delirium

老年骨折患者全麻手术后较易引发谵妄，导致患者认知功能出现障碍，增加住院时间等不良后果。术后谵妄的发生与麻醉的药物有关，麻醉剂量的氯胺酮只能暂时抑制老年大鼠的认知能力，因此会使术后谵妄的发生概率增加[1]。而亚麻醉剂量氯胺酮因副作用及镇定作用较小，已在临床上广泛运用。右美托咪啶具有较好的镇定作用，是一种新型的镇静药物，可减少炎症因子和应激反应，降低重症患者的谵妄发生率[2]。但其……