Zhu Yong, Le Guohui
Department of Anesthesiology, The Sixth People's Hospital of Kunshan City Kunshan 215321, Jiangsu, China.
Department of Anesthesiology, Traditional Chinese Medicine Hospital of Kunshan City Kunshan 215321, Jiangsu, China.
Am J Transl Res. 2021 Oct 15;13(10):12058-12064. eCollection 2021.
To investigate the effect of dexmedetomidine combined with epidural anesthesia on cognitive dysfunction (POCD) in elderly patients after orthopedic surgery.
A total of 187 elderly patients who needed orthopedic surgery in our hospital from January 2019 to December 2020 were randomly divided into an experimental group (n=95) and a control group (n=92). The patients in the experimental group were administered 1 μg/kg dexmedetomidine hydrochloride injections, and the patients in the control group were administered 0.9% sodium chloride injections, which were infused using a micropump for about 10 minutes. The two groups' cognitive function, VAS scores, and vital signs were compared.
There were significant differences in the two groups' mean arterial pressures and heart rates at intubation time (T3), operation start time (T4), and extubation time (T6) (P < 0.05). The VAS scores in the experimental group were significantly different from the VAS scores in the control group at 24 hours after the operations, 48 hours after the operations, 72 hours after the operations, and 7 days after the operations (P < 0.05). There were no significant differences in the anesthesia times, the average bleeding volumes, or the average operative durations (P > 0.05). 48 hours after the operations, the MMSE score in the experimental group was (27.15±1.17), which was significantly different than the MMSE score in the control group (23.11±0.83), and the difference was statistically significant (P < 0.05).
Epidural anesthesia combined with dexmedetomidine has little circulatory interference in elderly patients; moreover, it can reduce the incidence of postoperative cognitive dysfunction in elderly patients.
探讨右美托咪定联合硬膜外麻醉对老年骨科手术后认知功能障碍（POCD）的影响。
选取2019年1月至2020年12月在我院需行骨科手术的187例老年患者，随机分为实验组（n = 95）和对照组（n = 92）。实验组患者给予1μg/kg盐酸右美托咪定注射液，对照组患者给予0.9%氯化钠注射液，均用微量泵输注约10分钟。比较两组患者的认知功能、视觉模拟评分（VAS）及生命体征。
两组患者在插管时（T3）、手术开始时（T4）及拔管时（T6）的平均动脉压和心率差异有统计学意义（P < 0.05）。实验组术后24小时、48小时、72小时及7天时的VAS评分与对照组比较差异有统计学意义（P < 0.05）。两组患者的麻醉时间、平均出血量及平均手术时长差异无统计学意义（P > 0.05）。术后48小时，实验组简易精神状态检查表（MMSE）评分为（27.15±1.17），与对照组（23.11±0.83）比较差异有统计学意义（P < 0.05）。
硬膜外麻醉联合右美托咪定对老年患者循环干扰小，且可降低老年患者术后认知功能障碍的发生率。
