Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland).
Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland).
Med Sci Monit. 2018 Dec 10;24:8925-8932. doi: 10.12659/MSM.911366.
BACKGROUND This study was designed to evaluate the effects of combined usage of dexmedetomidine (DEX) and sufentanil on young patients with postoperative delirium (POD) after general anesthesia. MATERIAL AND METHODS We randomized 100 young patients with POD into 4 groups: Group D, Group S, Group DS1, and Group DS2, with loading and maintenance doses of DEX and/or sufentanil administered according to the experimental protocol. Hemodynamic variables, standard visual analogue scale (VAS) scores, sedation agitation scale (SAS) scores, stress hormones, and inflammatory biomarkers were assessed at 5 time-points: baseline (T1); 1 h (T2), 2 h (T3), 4 h (T4), and 8 h (T5) after completion of the loading dose. RESULTS At T3-T5, hemodynamic indicators in group D were obviously higher than in the other groups (P<0.05). At T2-T5, the VAS and SAS scores were noticeably lower than those at T1 in each group (P<0.05). The VAS and SAS scores were remarkably higher in group D than those in the other groups (P<0.05). Compared with DS1, the incidence of respiratory distress decreased and the incidence of POD increased in group DS2. Compared to T1, plasma concentrations of epinephrine, norepinephrine, IL-6, and TNF-a all decreased at T2 and T5 (P<0.05). CONCLUSIONS DEX and sufentanil decrease the incidence of POD, ameliorate the abnormities of hemodynamic indicators, and decrease VAS scores, SAS scores, stress hormones, and inflammatory biomarkers, but increase the incidence of respiratory distress. DEX combined with sufentanil may play a synergistic reaction in causing respiratory distress, but remarkably decreases the incidence of POD.
背景 本研究旨在评估右美托咪定(DEX)和舒芬太尼联合使用对全麻后发生术后谵妄(POD)的年轻患者的影响。
材料与方法 我们将 100 例 POD 年轻患者随机分为 4 组:DEX 组、舒芬太尼组、DEX+舒芬太尼 1 组(DS1 组)和 DEX+舒芬太尼 2 组(DS2 组),根据实验方案给予DEX 和/或舒芬太尼的负荷量和维持量。在 5 个时间点(T1):基线;负荷量输注完成后 1 小时(T2)、2 小时(T3)、4 小时(T4)和 8 小时(T5)评估血流动力学变量、标准视觉模拟评分(VAS)、镇静躁动评分(SAS)、应激激素和炎症生物标志物。
结果 在 T3-T5 时,DEX 组的血流动力学指标明显高于其他组(P<0.05)。在 T2-T5 时,每组 VAS 和 SAS 评分均明显低于 T1 时(P<0.05)。DEX 组的 VAS 和 SAS 评分明显高于其他组(P<0.05)。与 DS1 组相比,DS2 组的呼吸窘迫发生率降低,POD 发生率增加。与 T1 相比,T2 和 T5 时血浆肾上腺素、去甲肾上腺素、IL-6 和 TNF-a 浓度均降低(P<0.05)。
结论 DEX 和舒芬太尼降低 POD 的发生率,改善血流动力学指标异常,降低 VAS 评分、SAS 评分、应激激素和炎症生物标志物,但增加呼吸窘迫的发生率。DEX 联合舒芬太尼可能在引起呼吸窘迫方面发挥协同作用,但可显著降低 POD 的发生率。