目的 探讨老年全髋关节置换术后患者在右美托咪定的前提下应用小剂量奥氮平对谵妄和脑内神经递质指标的影响。方法 本文选取2022年6月至2023年10月于河南省洛阳正骨医院(河南省骨科医院)行全髋关节置换术的老年患者120例，将其按照治疗方法分为对照组60例和研究组60例。2组患者入室后均将右美托咪定溶入0。9％氯化钠注射液中，对患者进行静脉滴注，直到患者的躁动-镇静评分在0分时停止静脉滴注。在此前提下，另外给予研究组患者奥氮平片口服，患者服用时间为7 d。将2组患者术中体征各项指标，体动发生率，术后谵妄发生情况，谵妄持续时间，术前、术后24 h的神经递质水平进行对比，并对2组患者各时间点简易精神状态量表(MMSE)评分进行对比。结果 研究组患者心率(HR)、收缩压(SBP)、舒张压(DBP)指标水平[(72。3±0。4)次/min、(140±9)mmHg、(92。8±3。0)mmHg]及体动发生率(3。3％)均相较于对照组[(72。9±0。8)次/min、(146±10)mmHg、(94。9±3。2)mmHg、16。7％]下降，而血氧饱和度(SpO2)指标(99。9±0。5)％相较于对照组(98。2±0。6)％上升(P均＜0。05);研究组患者谵妄发生率为6。7％，比对照组的28。3％低(P均＜0。05);术后24 h 2组患者5-羟色胺(5-HT)、多巴胺(DA)水平均相较于术前下降，且研究组患者[(150±13)μg/L、(41±6)μg/L]均比对照组[(183±14)μg/L、(51±8)μg/L]低(均 P＜0。05);相较于术前，术后 24、48、72 h简易精神状态检查表(MMSE)评分均下降，而研究组患者术后24 h MMSE评分相较于术前下降，研究组患者术后24 h、48 h、72 h MMSE评分[(26±3)分、(27±4)分、(27±4)分]均相较于对照组[(24±3)分、(25±4)分、(25±5)分]上升(P均＜0。05)，研究组患者术后48 h、72 h MMSE评分相较于术前，差异无统计学意义(P＞0。05)。结论 右美托咪定联合小剂量奥氮平应用于老年全髋关节置换术后患者中，可使谵妄的发生率下降，有助于认知功能的改善，但对谵妄症状仍无法逆转。
Effects of dexmedetomidine combined with low-dose olanzapine on postoperative delirium and neurotrans-mitters in elderly patients undergoing total hip replacement
Objective To investigate the effects of effects of dexmedetomidine combined with low-dose olanzapine on postoperative delirium and neurotransmitters in elderly patients undergoing total hip replacement.Methods A total of 120 elderly patients who underwent total hip replacement surgery at Luoyang Orthopaedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopaedic Hospital)from June 2022 to October 2023 were included in this study.They were divided into a control group(60 cases)depenging on the treatment method.After entering the operating room,the patients in both groups received intravenous infusion of dexmedetomidine dissolved in sodium chloride solution until their agitation-sedation score reached 0.On this basis,patients in the study group were given oral olanzapine tablets for 7 days.The intraoperative physiological indicators,occurrence of body movement,postoperative delirium occurrence and duration,preoperative and postoperative 24-hour neurotransmitter levels,as well as the Mini-Mental State Examination(MMSE)scores at each time points were all compared between the two groups.Results The levels of heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)indicators in the study group[(72.3±0.4)times/min,(140±9)mmHg,(92.8±3.0)mmHg]and the incidence of physical activity(3.3％)decreased compared to the control group[72.9±0.8)times/min,(146±10)mmHg,(94.9±3.2)mmHg,16.7％],while the SpO2 indicator(99.9±0.5)％was lower than that of the control group(98.2±0.6)％increase(all P＜0.05);The incidence of delirium in the study group was 6.7％,which was lower than the 28.3％in the control group(all P＜0.05);After 24 hours of surgery,the levels of 5-hydroxytryptamine(5-HT)and dopamine(DA)in both groups of patients decreased compared to preoperative levels,and the study group patients[(150±13)μg/L,(41±6)μg/L was lower than the control group[(183±14)μg/L,(51±8)μg/L](all P＜0.05);Compared to preoperative,the Mini Mental State Examination(MMSE)scores at 24,48,and 72 hours after surgery all decreased,while the MMSE scores at 24 hours after surgery in the study group significantly decreased compared to preoperative.The MMSE scores at 24 hours,48 hours,and 72 hours after surgery in the study group[(26±3)scores,(27±4)scores,(27±4)scores]all increased compared to the control group[(24±3)scores,(25±4)scores,(25±5)scores](all P＜0.05),and the MMSE scores at 48 hours and 72 hours after surgery in the study group increased compared to preoperative,the difference was not statistically significant(P＞0.05).Conclusion Dexmedetomidine combined with low-dose olanzapine can reduce the incidence of delirium and improve cognitive function in elderly patients after total hip arthroplasty,but the symptoms of delirium are still irreversible.
万方数据
维普
