Clinical Study Of Dexmedetomidine In The Treatment Of Delirium After Hip And Knee Replacement

Objective To observe the clinical efficacy and safety evaluation of Dexmedetomidine?DEX?in the treatment of Postoperative Delirum?POD?after hip and knee replacement,and to explore its mechanism of action.Methods Select patients undergoing elective hip-knee replacement?November 2018 to December 2019?,ASA I or II,aged?65 years,body mass index?BMI?between 18 to 29kg/m².The CM-CR score and DSM-V scale were used for evaluation from 1 to 7 days later.A total of 68 patients with POD were collected.They were randomly divided into two groups:DEX treatment group?group D?and haloperidol treatment group?group C?.During treatment in group D,rereceving an intravenous infusion of DEX at 1.0?g/kg for 15 min,and then the dose was adjusted to 0.2 to 0.7?g/kg/h for continuous intravenous pumping.In group C,haloperidol was initially dosed at 2.5 mg/d,and the therapeutic amount was 2.5-10 mg/d.The intervention endpoints for each group were CAM-CR scores and DSM-5 scale assessments for two consecutive negative or up to 7-day treatments.The heart rate?HR?,mean arterial pressure?MAP?,respiration rate?RR?and pulse oxygen saturation?SpO₂?were recorded at the time of diagnosis?T0?,the first day of treatment?T1?,the second day?T2?,and the third day?T3?.Ramsay sedation scores were recorded at the time of 1,6,12,24,36,and 48h in patients.Sleep quality scores were recorded at T0,T1,T2,and T3.The POD classification,duration,and length of stay in patients were recorded.Blood samples were taken at T0,T1,T2,and T3 to detect the serum concentrations of norepinephrine?NE?,epinephrine?E?,cortisol?Cor?,interleukin-6 and tumor necrosis factor-??TNF-??.The occurrence of adverse reactions?bradycardia,hypotension,hypotension saturation?and mortality after 30 days in patients were recorded.Results There were no significant differences among two groups for general conditions and vital signs of patients?P>0.05?.Compared with group C,the Ramsay sedation scores of patients in group D at 6h and 12h were significantly increased?P<0.05?.The sleep quality scores of patients in the group were significantly increased when POD was diagnosed.With the progress of treatment,compared with group C,the sleep quality scores of patients in group D at T1,T2,and T3,significantly decreased?P<0.05?.Compared with group C,the duration of delirium and the length of hospital stay were significantly shorter in group D?P<0.05?.The serum concentrations of E,NE,Cor,IL-6 and TNF-?increased without any difference at T0 in patients.With the progress of treatment,compared with group C,the serum concentrations of NE,E,Cor,IL-6 and TNF-?in group D decreased obviously at T1,T2,and T3?P<0.05?.There were no statistically significant differences in adverse reactions and30-day mortality after treatment between the two groups?P>0.05?.Conclusion Dexmedetomidine can be safely and effectively used to treat delirium after hip and knee replacement.The mechanism is to suppress brain stress and reduce the expression of inflammatory cytokines,and may provide a new method for clinical treatment of delirium after surgery.