低剂量右美托咪定对老年髋部骨折术后炎症反应及谵妄的影响

doi:10.3969/j.issn.1006-7795.2024.02.008

摘要/Abstract

摘要： 目的评估预防性使用低剂量右美托咪定（dexmedetomidine,DEX)对老年髋部骨折患者术后炎症反应的影响。方法将入住重症监护病房（intensive care unit,ICU）的老年髋部骨折术后患者采用数字表法随机分配到DEX组或对照组，即刻分别给予DEX 0.1 μg·kg^-1·h^-1及0.9%（质量分数）氯化钠注射液，相同液速（0.025 mL·kg^-1·h^-1）静脉泵入。测定给药后0(即刻)、6、12、18 h患者血清降钙素原和白细胞介素-6浓度，记录血流动力学参数（心指数、每搏量指数、平均动脉压、心率）及谵妄的发生。结果两组间降钙素原及白细胞介素-6在各个时间点的差异无统计学意义（P>0.05），DEX组出现谵妄的例数显著低于对照组（P=0.034）。DEX组额外使用阿片类镇痛药物的例数（P=0.039）以及出现高血压的例数（P=0.012）显著低于对照组。结论低剂量DEX未显著降低老年髋部骨折患者术后的炎症指标，但有助于减少老年髋部骨折患者谵妄的发生及阿片类药物的使用。低剂量DEX对于血流力学影响较小，对术后高血压的患者可能具有一定循环保护作用。

关键词: 右美托咪定, 老年髋部骨折, 谵妄, 血流动力学, 炎症反应

Abstract: Objective To evaluate the effect of prophylactic administration of low-dose dexmedetomidine (DEX) on inflammatory response in elderly patients after hip fracture surgery. Methods Elderly patients with hip fractures who admitted to the intensive care unit (ICU) after surgery were randomly divided to two groups, labeled “DEX group” or “control group” DEX. DEX group were received a continuous infusion of 0.1 μ g·kg^-1·h^-1 DEX. Control group received 0.025 mL·kg^-1·h^-1 of 0.9% saline intravenously. The serum levels of procalcitonin and interleukin-6 in patients at 0 hours (immediate), 6 hours, 12 hours, and 18 hours after administration were detected. The hemodynamic parameters (heart index, stroke volume index, mean arterial pressure, heart rate) and the occurrence of delirium were recorded. Results There was no statistically significant difference in the levels of procalcitonin and interleukin-6 between the two groups at each time points (P>0.05).The incidence of delirium in the DEX group was significantly lower than that in the control group (P=0.034). The number of cases of additional use of opioid in the DEX group (P=0.039) and hypertension (P=0.012) were significantly lower than those in the control group. Conclusion Low dose DEX did not significantly reduce postoperative inflammatory indicators in elderly patients with hip fractures, but it helped to reduce the occurrence of delirium and use of opioid analyesics in patients. Low dose DEX has minimal impact on hemodynamics and may have a circulatory protective effect on patients with postoperative hypertension.

Key words: dexmedetomidine, hip fracture in the elderly, delirium, hemodynamic, inflammatory response

中图分类号:

崔真, 于淼淼, 孔月月, 柯丽, 张柳, 白颖, 王郝. 低剂量右美托咪定对老年髋部骨折术后炎症反应及谵妄的影响[J]. 首都医科大学学报, 2024, 45(2): 220-225.

Cui Zhen, Yu Miaomiao, Kong Yueyue, Ke Li, Zhang Liu, Bai Ying, Wang Hao. Effect of low-dose dexmedetomidine on postoperative inflammatory response and delirium in elderly patients with hip fractures[J]. Journal of Capital Medical University, 2024, 45(2): 220-225.

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