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摘要
Objective: To study the preventive effect of dexmedetomidine (DEX) on the postoperative delirium (POD) in elderly patients aged over 75 years old after vertebral fracture operation, and its regulating effect on the depth of anesthesia during operation. Methods: A total of 90 patients aged 75-90 years old with vertebral fractures surgically treated under general anesthesia in Nanxiang Hospital of Shanghai Jiading District from January 2015 to December 2017 were enrolled in this study. They were randomly divided into the DEX group (group A, n=30), the midazolam group (group B, n=30) and the control group (group C, n=30). Group A was injected with DEX (0.5 mu g/kg) through a pump for 10 min before anesthesia induction, and then the drug was maintained at 0.4 mu g/(kg.h) until the end of operation; group B received intravenous injection of 0.03 mg/kg midazolam; group C was given the same dose of normal saline. During operation, the bispectral index (BIS) was used to monitor the depth of anesthesia, which was maintained by adjusting the inspired concentration of sevoflurane (BIS value: 55-60). The operation time, intraoperative blood loss, extubation time, Richmond Agitation-Sedation Scale at extubation, intraoperative sevoflurane dosage, statuses of postoperative nausea, vomiting, dizziness and other adverse reactions, and delirium assessment at 1-5 days after operation (confusion assessment method) were recorded and compared. Results: There were no significant differences in general condition, operation time, intraoperative blood loss and fracture site among the three groups of patients (all P>0.05). Extubation time in group B was longer than those in group A and C (P<0.05), and there was no significant difference in extubation time between group A and C (P>0.05). The agitation rates at extubation of patients in group B and C were significantly higher than that in group A (P<0.05). The intraoperative dosage of sevoflurane in group A was obviously less than those in group B and C (P<0.05). There were no significant differences in the incidence rate of postoperative adverse reactions among the three groups of patients (P>0.05). The incidence rate of POD in group A was apparently lower than those in group B and C (P<0.05); the incidence rate of POD at 1-2 days after operation in group B was higher than that in group C (P<0.05); there was no significant difference in the incidence rate of POD at 3-5 days after operation between group B and C (P>0.05). Conclusion: DEX not only had a good sedative effect, but also could be used in combination with sevoflurane to control the depth of anesthesia, reduce the dosage of sevoflurane, and lower the incidence rate of POD in elderly patients after vertebral fracture operation and the agitation rate at extubation under general anesthesia.
- 出版日期2018
- 单位复旦大学
