【摘要】 目的 观察极低剂量盐酸右美托咪定注射液联合注射用盐酸瑞芬太尼和丙泊酚乳状注射液持续泵注对全髋关节置换术（THA）老年患者的临床疗效和安全性。方法 将THA老年患者按照给药方式分为试验组与对照组。对照组以静脉注射的方式予以剂量为0.3μg·kg^-1的枸橼酸舒芬太尼注射液、剂量为1.0～2.5mg·kg^-1的丙泊酚乳状注射液、剂量为0.6～0.9mg·kg^-1的罗库溴铵注射液进行麻醉诱导，以静脉泵注的方式予以剂量为4～6mg·kg^-1·h^-1的丙泊酚乳状注射液，剂量为0.1～0.2μg·kg^-1·h^-1的注射用盐酸瑞芬太尼进行麻醉维持；试验组于麻醉诱导前给予盐酸右美托咪定注射液0.2～0.5μg·kg^-1，于麻醉诱导后至术毕前30min给予极低剂量盐酸右美托咪定注射液0.1～0.2μg·kg^-1·h^-1静脉泵注，其他同对照组。比较2组患者在入室后（T₀）、气管插管后即刻（T₁）、上止血带时（T₂）、切除坏死骨及组织时（T₃）、假体植入时（T₄）、松止血带时（T₅）、拔管后即刻（T₆）的生命体征，改良警觉镇静/评分（MOAA/S），治疗过程中的麻醉药用量、术后谵妄发生情况、术前术后神经元损伤指标和神经递质指标，并进行安全性评价。结果 本研究共入组120例，试验组63例、对照组57例。T₁时，试验组和对照组的心率（HR）分别为（79.68±7.34）和（76.79±8.40）times·min^-1;T₂时，分别为（81.43±7.37）和（78.68±7.49）times·min^-1;T₃时，分别为（83.83±7.53）和（80.35±7.14）times·min^-1;T₄时，分别为（82.63±6.90）和（79.77±7.39）times·min^-1;T₅时，分别为（81.27±7.31）和（78.16±7.51）times·min^-1;T₆时，分别为（86.16±7.32）和（83.74±7.31）times·min^-1，试验组各时刻的心率均显著高于对照组（均P<0.05）。T₁时，试验组和对照组的平均动脉压（MAP）分别为（80.29±9.89）和（75.32±9.73）times·min^-1;T₂时，分别为（82.10±10.00）和（77.18±9.82）times·min^-1;T₃时，分别为（83.16±9.95）和（79.46±10.06）times·min^-1;T₄时，分别为（82.83±9.58）和（77.19±9.92）times·min^-1;T₅时，分别为（81.30±9.59）和（76.09±9.82）times·min^-1;T₆时，分别为（84.14±9.87）和（82.12±9.97）times·min^-1，试验组各时刻的MAP均显著高于对照组（均P<0.05）。T₁时，试验组和对照组的MOAA/S分别为（2.05±0.28）和（2.23±0.46）分；T₂时，分别为（1.92±0.33）和（2.09±0.51）分；T₃时，分别为（1.95±0.42）和（2.09±0.34）分；T₄时，分别为（1.92±0.33）和（2.11±0.36）分；T₅时，分别为（1.92±0.33）和（2.07±0.37）分；T₆时，分别为（3.30±0.73）和（3.77±0.80）分，试验组各时刻的MOAA/S评分均显著低于对照组（均P<0.05）。试验组和对照组术中丙泊酚用量分别为（381.81±46.48）和（407.25±49.36）mg，术中瑞芬太尼用量分别为（14.43±1.82）和（15.14±2.00）μg，术后72h谵妄发生率分别为15.87%和33.33%，术后24h中枢神经特异性蛋白（S100β）水平分别为（0.59±0.11）和（0.66±0.14）μg·mL^-1，术后24h神经胶质酸性蛋白（GFAP）水平分别为（0.8 7±0.29）和（1.02±0.22）ng·mL^-1，术后8h5-羟色胺（5-HT）水平分别为（168.91±18.25）和（159.35±17.54）μg·L^-1，试验组的上述指标与对照组比较，在统计学上差异均有统计学意义（均P<0.05）。试验组和对照组的药物不良反应总发生率分别为12.70%和22.81%，在统计学上差异无统计学意义（P>0.05）。结论 THA老年患者应用极低剂量盐酸右美托咪定注射液联合注射用盐酸瑞芬太尼和丙泊酚乳状注射液持续泵注能够有效改善术中生命体征等情况及术后苏醒质量，增强镇痛镇静效果，减少注射用盐酸瑞芬太尼和丙泊酚乳状注射液用量，降低术后谵妄发生率，调节神经元损伤指标和神经递质指标水平，并且安全性良好。更多还原

【Abstract】 Objective To observe the clinical efficacy and safety of continuous infusion of extremely low-dose dexmedetomidine hydrochloride injection combined with remifentanil hydrochloride for injection and propofol emulsion injection in elderly patients undergoing total hip arthroplasty（THA）.Methods Elderly patients undergoing THA were divided into treatment group and control group according to the administration method.The control group was induced with intravenous injection of sufentanil citrate injection at a dose of 0.3 μg·kg^-1,propofol emulsion injection at a dose of 1.0-2.5 mg·kg^-1,and rocuronium bromide injection at a dose of 0.6-0.9 mg·kg^-1.Anesthesia was maintained with intravenous infusion of propofol emulsion injection at a dose of 4-6 mg·kg^-1·h^-1 and remifentanil hydrochloride for injection at a dose of 0.1-0.2 μg · kg^-1·h^-1.The treatment group received dexmedetomidine hydrochloride injection 0.2-0.5 μg·kg^-1 before anesthesia induction,followed by ultra-low dose dexmedetomidine hydrochloride injection 0.1-0.2 μg·kg¹·h^-1 intravenous infusion from after anesthesia induction to 30 min before the end of the operation,with other treatments the same as the control group.The vital signs of the two groups were compared after entering the room（T₀）,immediately after tracheal intubation（T₁）,at the time of upper tourniquet（T₂）,when necrotizing bone and tissue were removed（T₃）,when prosthesis was implanted（T₄）,when tourniquet was released（T₅） and immediately after extubation（T₆） and the modified alert sedation/score（MOAA/S） was improved;the dosage of anesthetics,the occurrence of postoperative delirium,preoperative and postoperative neuronal injury markers,and neurotransmitter markers were compared between the two groups,and safety was evaluated.Results A total of 120 patients were enrolled,including 63 cases in the treatment group and 57 cases in the control group.At T₁,the heart rate（HR） of treatment group and control group were（79.68±7.34） and（76.79±8.40）times·min^-1,respectively;at T₂,they were（81.43±7.37） and（78.68±7.49） times·min^-1,respectively;at T₃,they were（83.83±7.53） and（80.35±7.14） times·min^-1,respectively;at T₄,they were（82.63±6.90）and（79.77±7.39） times·min^-1,respectively;at T₅,they were（81.27±7.31） and（78.16±7.51） times·min^-1,respectively;at T₆,they were（86.16±7.32） and（83.74±7.31） times·min^-1,respectively.The heart rate of treatment group at each time were all significantly higher than those of control group（all P <0.05）.At T₁,the mean arterial pressure（MAP） of treatment group and control group were（80.29±9.89） and（75.32±9.73） times·min^-1,respectively;at T₂,they were（82.10±10.00） and（77.18±9.82） times·min^-1,respectively;at T₃,they were（83.16±9.95） and（79.46±10.06） times·min^-1,respectively;at T₄,they were（82.83±9.58） and（77.19±9.92） times·min^-1,respectively;at T₅,they were（81.30±9.59） and（76.09±9.82） times·min^-1,respectively;at T₆,they were（84.14±9.87） and（82.12±9.97） times·min^-1,respectively.The MAP of treatment group at each time were all significantly higher than those of control group（all P <0.05）.At T₁,the MOAA/S of treatment group and control group were（2.05±0.28） and（2.23±0.46） score,respectively;at T₂,the scores were（1.92±0.33） and（2.09±0.51） score,respectively;at T₃,the scores were（1.95±0.42） and（2.09±0.34） score,respectively;at T₄,the scores were（1.92±0.33） and（2.11±0.36） score,respectively;at T₅,the scores were（1.92±0.33） and（2.07±0.37） score,respectively;at T6,the scores were（3.30±0.73） and（3.77±0.80） score,respectively.The MOAA/S scores of treatment group at each time were all significantly lower than those of control group（all P <0.05）.The intraoperative propofol dosage in treatment group and control group were（381.81±46.48） and（407.25±49.36） mg,respectively;the intraoperative remifentanil dosage were（14.43±1.82） and（15.14±2.00） μg,respectively;the incidence of postoperative delirium at 72 h were 15.87%and 33.33%,respectively;the postoperative 24 h central nervous system-specific protein（S100β） levels were（0.59±0.11） and（0.66±0.14） μg · mL^-1,respectively;the postoperative 24 h glial fibrillary acidic protein（GFAP） levels were（0.87±0.29） and（1.02±0.22） ng · mL^-1,respectively;the postoperative 8 h5-hydroxytryptamine（5-HT） levels were（168.91±18.25） and（159.35±17.54） μg · L^-1,respectively,with statistically significant differences（all P <0.05）.The total incidence of adverse drug reactions were 12.70% in treatment group and 22.81% in control group,respectively,with no statistically significant difference（P> 0.05）.Conclusion Continuous infusion of extremely low-dose dexmedetomidine hydrochloride injection combined with remifentanil hydrochloride for injection and propofol emulsion injection in elderly patients undergoing THA can effectively improve intraoperative vital signs and postoperative recovery quality,enhance analgesia and sedation,reduce the dosage of remifentanil hydrochloride for injection and propofol emulsion injection,reduce the incidence of postoperative delirium,regulate the levels of neuronal injury markers and neurotransmitter markers,and has good safety.更多还原