Clinical study of dexmedetomidine on postoperative delirium in elderly patients following hip surgery

doi:10.3877/cma.j.issn.2096-0263.2018.06.004

Abstract

Abstract:

Objective

To explore the effect of dexmedetomidine on postoperative delirium in elderly patients following hip surgery.

Methods

Fifty patients over 65 years following hip surgery were admitted from January 2016 to to January 2018, they were randomly divided into two groups: dexmedetomidine group (n=25) which was given dexmedetomidine for postoperative analgesia with a does of 0.5 μg/kg/hr followed by orthopedic routine treatment and control group (n=25) which was only given with routine treatment. The incidence, onset time and duration of delirium were compared between two groups.

Results

All patients were well followed up with a mean duration of (10.0±1.4) days (range, 7-15 days). There was no statistical difference between dexmedetomidine group (6%) and control group (13%) on the incidence of delirium (P>0.05). There was significant difference between dexmedetomidine group [(26±6) h] and control group [(7±3) h] on the onset time of delirium (t=2.370, P<0.05). There was significant difference between dexmedetomidine group [(2.4±0.8) d] and control group [(6.2±1.5) d] on the duration of delirium (t=-1.942, P<0.05).

Conclusion

Dexmedetomidine could delay the onset time and shorten the duration of delirium, but could not lower the incidence of delirium.

Key words: Dexmedetomidine, Postoperative delirium, Aged, Hip

Chen Jiang, Hua Cui, Jiangfeng Gong, Hui Xu. Clinical study of dexmedetomidine on postoperative delirium in elderly patients following hip surgery[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(06): 336-340.

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References 26

1	Aldecoa C, Bettelli G, Bilotta F, et al. European society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J]. Eur J Anaesthesiol, 2017, 34(4):192-214.
2	Rizk P, Morris W, Oladeji P, et al. Review of postoperative delirium in geriatric patients undergoing hip surgery[J]. Geriatr Orthop Surg Rehabil, 2016, 7(2):100-105.
3	Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment[J]. Nat Rev Neurol, 2009, 5(4):210-220.
4	Bickel H, Gradinger R, Kochs E, et al. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study[J]. Dement Geriatr Cogn Disord, 2008, 26(1):26-31.
5	邬耀军，庞清江，刘江涛,等.老年髋部手术后谵妄发病率的Meta分析[J].中国骨伤, 2015, 28(12):1156-1161.
6	Hu H, Deng W, Liu Y. Olanzapine and haloperidol for senile delirium: a randomized controlled observation[J]. Chin J Clin Rehab, 2006, 10:188-190.
7	Bourne RS, Tahir TA, Borthwick M, et al. Drug treatment of delirium: past, present and future[J]. J Psychosom Res, 2008, 65(3):273-282.
8	李娟，邹义壮，冯峰,等.谵妄评定方法修订及其信度、效度测试[J].临床精神医学杂志, 2003, 3:147-149.
9	Girard TD, Ely EW. Delirium in the critically ill patient[J]. Handb Clin Neurol, 2008, 90:39-56.
10	Inouye SK. Delirium in older persons[J]. N Engl J Med, 2006, 354(11):1157-1165.
11	Pisani MA, McNicoll L, Inouye SK. Cognitive impairment in the intensive care unit[J]. Clin Chest Med, 2003, 24(4):727-737.
12	US Department of Health and Human Service. CMS statistics. Washington, DC: Centers for Medicare and Medicaid Services; 2004.
13	冯传江，姚琴琴，欧丹丹,等. ICU谵妄的研究进展[J].中华临床医师杂志(电子版), 2016, 10(18):2785-2788.
14	张立智，张世民.老年髋部骨折术后谵妄的研究进展[J].中国矫形外科杂志, 2014, 22(4):324-327.
15	Hshieh TT, Fong TG, MarcantonioER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence[J]. J Gerontol A Biol Sci Med Sci, 2008, 63(7):764-772.
16	Eikelenboom P, Hoogendijk WJ. Do delirium and Alzheimer's dementia share specific pathogenetic mechanisms?[J]. Dement Geriatr Cogn Disord, 1999,10(5):319-324.
17	Maclullich AM1, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses[J]. J Psychosom Res, 2008, 65(3):229-238.
18	Inouye SK, Robinson T, Blaum C, et al. Postoperative delirium in older adults:best practice statement from the American Geriatrics Society[J]. J Am Coll Surg, 2015, 220(2):136-148.
19	Sieber FE. Postoperative delirium in the elderly surgical patient[J]. Anesthesiol Clin, 2009, 27(3):451-464, table of contents.
20	冯旭，陈辉，蔡宁宇,等.老年髋部骨折患者术后谵妄发生的危险因素分析[J].中国骨与关节损伤杂志, 2017, 32(2):113-116.
21	吕阳，刘启宇，刘军,等.中国老年髋部骨折患者术后发生谵妄相关危险因素的Meta分析[J].中国组织工程研究, 2018, 22(15):2437-2445.
22	Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review[J]. Age Ageing, 2006, 35(4):350-364.
23	Kratz T, Heinrich M, Schlauß E, et al. Preventing postoperative delirium[J]. Dtsch Arztebl Int, 2015, 112(17):289-296.
24	聂芳，李煜洁，曹建国,等.右美托咪定对术后谵妄的预防和治疗作用[J].国际麻醉学与复苏杂志, 2015, 5:436-439.
25	陈华敏，焦丰，黄重峰,等.盐酸右美托咪定对老年髋部骨折术后患者谵妄的影响[J].抗感染药学, 2015, 12(6):1040-1042.
26	樊强，卢波.右美托咪定对老年髋部骨折手术患者术后谵妄的影响[J].骨、关节损伤, 2017, 14:157-159.

组别	例数	年龄（岁，±s）	性别（例，男/女）	BMI （kg/m²，±s）	术前MMSE评分（分，±s）	手术时间（min，±s）
右美托咪定组	25	71±4	16/9	21.8±1.8	26±4	175±21
对照组	25	72±4	12/13	22.1±2.4	26±5	171±19
统计值	?	t=1.304	χ²=1.537	t=0.853	t=1.236	t=1.348
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	术中出血量（ml，±s）	补液量（ml，±s）	疾病类型（例）		手术方式
组别	例数	术中出血量（ml，±s）	补液量（ml，±s）	髋部骨折	股骨头坏死	人工髋关节置换术	股骨近端防旋髓内钉
右美托咪定组	25	210±45	2150±410	14	11	17	8
对照组	25	204±42	2090±421	16	9	15	10
统计值	?	t=0.619	t=1.834	χ²=1.30		χ²=0.78
P值	?	>0.05	>0.05	>0.05		>0.05

组别	例数	年龄（岁，±s）	性别（例，男/女）	BMI （kg/m²，±s）	术前MMSE评分（分，±s）	手术时间（min，±s）
右美托咪定组	25	71±4	16/9	21.8±1.8	26±4	175±21
对照组	25	72±4	12/13	22.1±2.4	26±5	171±19
统计值	?	t=1.304	χ²=1.537	t=0.853	t=1.236	t=1.348
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	术中出血量（ml，±s）	补液量（ml，±s）	疾病类型（例）		手术方式
组别	例数	术中出血量（ml，±s）	补液量（ml，±s）	髋部骨折	股骨头坏死	人工髋关节置换术	股骨近端防旋髓内钉
右美托咪定组	25	210±45	2150±410	14	11	17	8
对照组	25	204±42	2090±421	16	9	15	10
统计值	?	t=0.619	t=1.834	χ²=1.30		χ²=0.78
P值	?	>0.05	>0.05	>0.05		>0.05

组别	例数	谵妄发生例数（例）	术后谵妄发生时间（h，±s）	谵妄持续时间（d，±s）
右美托咪定组	25	2	26±6	2.4±0.8
对照组	25	3	7±3	6.2±1.5
统计值	?	χ²=2.251	t=2.370	t=-1.942
P值	?	0.113	0.015	0.027

组别	例数	谵妄发生例数（例）	术后谵妄发生时间（h，±s）	谵妄持续时间（d，±s）
右美托咪定组	25	2	26±6	2.4±0.8
对照组	25	3	7±3	6.2±1.5
统计值	?	χ²=2.251	t=2.370	t=-1.942
P值	?	0.113	0.015	0.027

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