The Effect Of Dexmedetomidine On Postoperative Delirium In Elderly Patients Undergoing Hip Fracture Operation

Objective:Postoperative delirium is a common temporarily impaired cognitive function and decreasing level of consciousness state of mind, it is one of the severe complications in elderly patients after operation and emergency diagnosis and treatment of medical emergency. Dexmedetomidine sedation is a relatively new; with sedative and analgesic effect. This study aimed to investigate the effect of DEX on PD in patients with hip fracture in aged patients.Methods: This study was the medical ethics committee of the second people’s Hospital of Anhui province approval, double blind, randomized, controlled study.59 cases of elderly hip surgery patients in our hospital in 2013 January ~June, 6 months of anesthesia were treated as the research object, and were randomly divided into dexmedetomidine group(n=30) and physiological-saline group(n=29). Dexmedetomidine group(group DEX) administered dexmedetomidine 0.5 μg/kg load, 10 min pump after anesthesia induction and treated with 0.4 μg?kg-1?h-1 maintenance; physiological-saline group(control group) received normal saline. Records of patients in operation of fluid intake and output, were recorded before(T1) and dexmedetomidine loading or saline infusion(T2), placed after laryngeal mask(T3), 10 min after the operation began(T4), laryngeal mask pulling(T5),(T6) left the operation room heart rate(HR), systolic pressure(SBP), diastolic pressure(DBP), bispectral index(BIS), pulse oxygen saturation(SPO2) and end-tidal carbon dioxide partial pressure(PETCO2); observe and record the two groups of patients after 10 min, 1h, 6h, 24 h, 48 h, Ramsay sedation score and Price-Henry score of pain; assessment of patients with postoperative delirium incidence using the delirium rating method; recording the use and operation of various drugs in patients with tachycardia occurred after corrosion and other adverse reactions.Results: The general information: General data of patients in the two groups of gender, age, MMSE score, height, weight, no significant difference(P > 0.05). Comparison of incidence of postoperative delirium: Patients in the two groups of quantity, colloidal crystal quantity, urine volume and extubation time and other indicators showed no significant difference(P > 0.05); postoperative delirium complications in two groups, but group DEX postoperative delirium incidence was significantly lower than the control group(6.67% VS 27.59%). The difference was statistically significant(P < 0.05). Anesthesia drugs comparison: The two groups of patients with midazolam, vecuronium bromide, ephedrine, atropine, nitroglycerin, esmolol dosage, no significant difference(P >0.05); compared with the control group, DEX group sufentanil dose(27.4 ± 2.6 ug VS 34.1 ± 3.0 ug), the dosage of propofol(346.8 ± 14.9 mg VS 390.5 ± 17.7 mg) significantly decreased, the difference was statistically significant(P < 0.05). Compared with each time point of vital signs of patients: Compared two groups of patients in T1, T2, T3, T4, T5, T6 Sp O2, PETCO2, nasal temperature group, no significant difference(P >0.05); compared with the control group, DEX group, T4, T5, SBP, DBP significantly, T2, T4, T5, HR decreased significantly(P < 0.05); compared with T1, T3, T4 DEX group SBP, DBP decreased, T4, T5 and control group SBP, DBP increased significantly, T2 ~ T4 DEX group, T3 group, HR decreased, T3, T4 two group BIS were significantly lower(P < 0.05). Comparison of Ramsay sedation score and Price-henry score of pain: Compared with the control group, patients in the DEX group after 10 min, 1h, and 6h Price-henry pain score decreased significantly(P <0.05); and comparison of 10 min after the operation, after 6, 24 and 48 h two Ramsay sedation score decreased significantly in group DEX patients with Price-henry pain score was significantly increased(P <0.05).Comparison of adverse reaction after operation: Two groups of postoperative echocardiography had adverse reaction speed, hypoxemia, vomiting, DEX group and control group after adverse reactions(63.3% VS 70%), no significant difference(P >0.05).Conclusion: Dexmedetomidine in 0.4μg·kg-1·h-1 dose after a bolus ?infusion at 0.5μg/kg for 10 min is effective in reducing the incidence rate of postoperative delirium in elderly patients undergoing hip fracture operation. It can effectively thrifty drug sufentanil and propofol anesthesia, the anesthesia hemodynamic stability, reduces the incidence of postoperative delirium, and has certain clinical application value.