术前应用氯胺酮复合右美托咪定对老年人术后谵妄的影响
发布时间：2018-09-07 12:44
【摘要】：研究背景：术后谵妄(POD)常见于接受大型手术的老年患者,增加患者术后护理难度,延长住院时间并且引起死亡率的增加；其常见于术后3天,发生率为10%至80%。术后谵妄的病理生理机制尚不明确,可能与认知功能改变有关。其发病的危险因素可能有老龄、低氧血症、低碳酸血症、严重疼痛等。既往研究中,氯胺酮和右美托咪定分别被成功应用于预防术后谵妄。 实验目的：本研究拟观察在择期行腹部手术的老年患者中,术前合用小剂量氯胺酮和右美托咪定(ketodex)对老年人术后谵妄的影响。 方法：在该前瞻、随机和双盲研究中,45名65岁以上,体重41-90kg, ASA Ⅰ-Ⅲ级,择期于全身麻醉下行腹部手术的患者分为两组,均于入室前30min肌注阿托品0.5mg,苯巴比妥100mg。其中ketodex组共23名患者,于全身麻醉诱导前5min静脉滴注给予右美托咪定(0.1μg/kg)和氯胺酮(0.5mg/kg)；对照组22名患者于全身麻醉诱导前5min给予相同容量的生理盐水。术中予以静吸复合维持麻醉,持续监测ECG、无创及有创血压、SP02、呼气末二氧化碳。术后连续3天与患者陪护或贴身护理的家属交谈,采用谵妄评估量表CAM量表)评估患者前1天谵妄的发生情况。依次询问患者陪护表中4个问题并描述患者前1天精神状况及行为学表现。如患者具备前2个问题中的表现且同时有问题3或问题4中阳性表现则可诊断患者发生了谵妄。 统计分析两组患者基本资料以及术后并发症等统计学特征,比较两组患者谵妄发生率及持续天数的差异。 CAM量表* 1.急性起病：(判断从前驱期到疾病发展期的时间)病人的精神状况有急性变化的证据吗?行为变化在过去的一天中有反复或者严重程度变化吗? 2.注意障碍：(请患者按顺序说出21到1之间的所有单数)患者的注意力难以集中吗?例如,容易注意涣散或难以交流吗? 3.思维混乱：患者的思维是凌乱或不连贯的吗?例如,谈话主题散漫或不中肯,思维不清晰或不合逻辑,或从一个话题突然转到另一话题? 4.意识水平的改变：总体上看,您觉得患者的意识水平是机敏(正常),警觉(对环境刺激高度警惕、过度敏感)嗜睡(瞌睡,但易于唤醒)或昏睡(难以唤醒)还是昏迷(不能唤醒)? 诊断标准：1+2+3/4为阳性即可诊断为谵妄 结果：最终39名患者完成研究,其中ketodex组20人,对照组19人。患者基本资料及术后并发症组间无明显差异。术后3天ketodex组有5人(25.00%)发生谵妄,对照组9人(47.37%)。两组患者POD发生率差异不明显(P0.05)。然而,对照组患者谵妄的持续天数较ketodex组患者长(1.89±0.601vs1.20±0.447,P0.05) 结论：择期行腹部手术的老年患者,全身麻醉诱导前给予小剂量氯胺酮及右美托咪定不能显著降低术后谵妄的发生率,但是可能缩短术后谵妄的持续时间。
[Abstract]:Background: postoperative delirium (POD) is common in elderly patients undergoing large-scale surgery, which increases postoperative nursing difficulty, prolongs hospitalization time and results in an increase in mortality, which occurs 3 days after operation, with an incidence rate of 10% to 80%. The pathophysiological mechanism of postoperative delirium is not clear and may be related to the change of cognitive function. Risk factors may include aging, hypoxemia, hypocapnia, severe pain, etc. In previous studies, ketamine and dexmetidine were successfully used to prevent postoperative delirium, respectively. Objective: to investigate the effect of low dose ketamine and dexmetidine (ketodex) on postoperative delirium in elderly patients undergoing abdominal surgery. Methods: in this prospective, randomized and double-blind study, 45 patients over 65 years old, weighing 41-90 kg, ASA 鈪，
本文编号：2228303
[Abstract]:Background: postoperative delirium (POD) is common in elderly patients undergoing large-scale surgery, which increases postoperative nursing difficulty, prolongs hospitalization time and results in an increase in mortality, which occurs 3 days after operation, with an incidence rate of 10% to 80%. The pathophysiological mechanism of postoperative delirium is not clear and may be related to the change of cognitive function. Risk factors may include aging, hypoxemia, hypocapnia, severe pain, etc. In previous studies, ketamine and dexmetidine were successfully used to prevent postoperative delirium, respectively. Objective: to investigate the effect of low dose ketamine and dexmetidine (ketodex) on postoperative delirium in elderly patients undergoing abdominal surgery. Methods: in this prospective, randomized and double-blind study, 45 patients over 65 years old, weighing 41-90 kg, ASA 鈪，
本文编号：2228303
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