2020 年第 7 期 第 15 卷

右美托咪定对老年全髋关节置换术患者血流动力学及术后定量脑电图的影响

Effect of dexmedetomidine on blood flow stability and quantitative electroencephalogram in elderly patients undergoing total hip replacement

作者：涂涛王劲王丽董蜀华

英文作者：Tu Tao Wang Jin Wang Li Dong Shuhua

单位：成都医学院第一附属医院麻醉科610500

英文单位：Department of Anesthesiology the First Affiliated Hospital of Chengdu Medical College Chengdu 610500 China

关键词：全髋关节置换术；右美托咪定；血流动力学；定量脑电图

英文关键词：otalhipreplacement；Dexmedetomidine；Bloodflowstability；Quantitativeelectroencephalogram

• 摘要：

• 目的探讨右美托咪定对老年全髋关节置换术患者血流动力学及术后定量脑电图（QEEG）的影响。方法选取2018年1月至2019年12月在成都医学院第一附属医院择期行全髋关节置换术的老年患者94例，根据随机数字表法分为对照组和观察组，各47例。对照组麻醉诱导前泵注0.9%氯化钠注射液；观察组麻醉诱导前泵注右美托咪定。记录2组患者入室后5 min（T0）、麻醉诱导即刻（T1）、气管插管时（T2）、术毕（T3）、拔管后（T4）平均动脉压和心率；比较2组患者T0、T2、T4时点肾上腺素、去甲肾上腺素水平；2组患者T0、T3、术后1 d（T5）时点的QEEG中δ和α1波频率；2组术后认知功能障碍（POCD）发生率。结果观察组T2、T3时点平均动脉压、心率明显低于T0、T1时点和对照组同时点（均P＜0.05）。 观察组T2、T4时点血浆肾上腺素、去甲肾上腺素与T0时点比较，差异均无统计学意义（均P＞0.05）；对照组T2、T4时点血浆肾上腺素、去甲肾上腺素浓度明显高于T0时点和观察组同时点（均P＜0.05）。观察组T3、T5时点左额区、右额区、左颞区、右颞区δ和α1波频率与T0时点比较差异均无统计学意义（均P＞0.05）；对照组T3、T5时点左额区、右额区、左颞区、右颞区δ波频率较T0时点明显升高、α1波频率较T0时点明显降低（均P＜0.05）；观察组T3、T5时点左额区、右额区、左颞区、右颞区δ波频率明显低于对照组、α1波频率明显高于对照组（均P＜0.05）。观察组POCD发生率明显低于对照组［6.4%(3/47)比25.5%（12/47）］（P＜0.05）。结论右美托咪定可维持全身麻醉下老年全髋关节置换术患者术中血流动力学稳定，使患者大脑额叶δ波频率降低，α1波频率升高，监测QEEG有助于POCD的及时发现。

• ObjectiveTo investigate the effect of dexmedetomidine on blood flow stability and quantitative electroencephalogram (QEEG) in elderly patients undergoing total hip replacement. Methods From January 2018 to December 2019, 94 elderly patients who underwent total hip replacement admitted to the First Affiliated Hospital of Chengdu Medical College were selected. They were randomly divided into control group and observation group, with 47 cases in each group. The control group was given 0.9% sodium chloride injection before anesthesia induction, and the observation group was given dexmedetomidine at the same time. The mean arterial pressure (MAP) and heart rate (HR) were recorded at 5 minutes after enter operating room (T0), immediately after anesthesia induction (T1), at tracheal intubation (T2), at the end of operation (T3), after extubation (T4). The levels of adrenaline (E), noradrenaline (NE) at T0, T2, T4 were compared between the two groups. The QEEG of T0, T3, and 1 day after operation (T5) of the two groups were recorded, and the δ and α1 wave frequencies of QEEG were calculated. The incidence of postoperative cognitive dysfunction (POCD) between the two groups were compared. Results  MAP and HR at  T2, T3 in the observation group were significantly lower than thoese at T0, T1 and those in the control group at the same time(all P＜0.05). In the observation group, there were no statistically significant differences in plasma E and NE among T2, T4 and T0 (all P＞0.05). The E and NE in the control group at T2 and T4 were significantly higher than those at T0 and in observation group at the same time (all P＜0.05). The frequency of δ and α 1 waves in the left frontal area, right frontal area, left temporal area and right temporal area of observation group at T3 and T5 had no significant difference compared with T0 (all P＞0.05). In the control group, the frequency of δ wave in left frontal area, right frontal area, left temporal area and right temporal area were significantly higher, and the frequency of α 1 wave was significantly lower than those in T0 (all P＜0.05). The frequency of δ wave in the left frontal area, right frontal area, left temporal area and right temporal area in the observation group were significantly lower than those in the control group and α 1 wave frequency was significantly higher than that in the control group (all P＜0.05). The incidence of POCD in the observation group was significantly lower than that in the control group ［6.4%(3/47) vs 25.5%(12/47)］(P＜0.05). Conclusion Dexmedetomidine can maintain the hemodynamic stability of the elderly patients undergoing total hip replacement under general anesthesia, reduce the frequency of δ wave and increase the frequency of α 1 wave. Monitoring QEEG is helpful for the timely detection of POCD.