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| 氟哌啶醇对老年髋关节置换手术患者术后谵妄的影响 |
| Effect of haloperidol on postoperative delirium incidence in elderly patients undergoing hip replacement surgery |
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| DOI：10.12089/jca.2019.06.007 |
| 中文关键词: 氟哌啶醇 髋关节置换术 术后谵妄 老年 |
| 英文关键词: Haloperidol Hip replacement surgery Postoperative delirium Elderly |
| 基金项目:安徽省公益性技术应用研究联动计划项目（1704f0804021） |
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| 中文摘要: |
目的 观察氟哌啶醇对老年髋关节置换手术患者术后谵妄（POD）影响。
方法 择期行单侧髋关节置换手术患者60例，男34例，女26例，年龄65～85岁，ASA Ⅰ—Ⅲ级，随机分为氟哌啶醇组（H组）和对照组（Ｃ组）。两组麻醉方法相同，手术结束后均行PCIA，H组：舒芬太尼2 μg/kg+氟比洛芬酯3 mg/kg+氟哌啶醇5 mg；Ｃ组：舒芬太尼2 μg/kg+氟比洛芬酯3 mg/kg，均由生理盐水配制成100 ml，以2 ml/h的速度持续静脉泵注48 h。观察并记录术后1、6、12、24、36、48 h Ramsay镇静评分和VAS疼痛评分。记录术后第１～3晚睡眠质量评分。采用意识混乱评估法（CAM）评定POD。记录术后心动过缓或心动过速、嗜睡、恶心呕吐和锥体外系症状等不良反应的发生情况。
结果 与Ｃ组比较，H组术后6 h和12 h的Ramsay镇静评分明显升高（P<0.05），术后6 h和12 h的VAS疼痛评分明显降低（P<0.05），术后第1晚和第2晚睡眠质量评分明显降低（P<0.05）。H组有２例（6.7%）发生POD，明显少于Ｃ组的9例（30.0%）（P<0.05）。H组术后恶心呕吐发生率明显低于Ｃ组（P<0.05）。两组其他不良反应发生率差异无统计学意义。
结论 术后行PCIA中加入5 mg氟哌啶醇可以降低老年髋关节置换手术患者术后谵妄的发生率，且改善术后转归。 |
| 英文摘要: |
Ojective To observe the effect of haloperidol on the incidence of postoperative delirium in elderly patients undergoing hip replacement surgery.
Methods Sixty elderly patients scheduled for hip replacement surgery, 34 males and 26 females, aged 65 - 85 years, falling into ASA physical status Ⅰ - Ⅲ, were enrolled in this study. All the patients were randomly divided into two groups: haloperidol group (group H) and control group (group C) with 30 cases in each. They were given patient-controlled intravenous analgesia(PCIA) after operation. Group H: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg+ haloperidol 5 mg; group C: sufentanil 2 μg/kg+ flurbiprofen 3 mg/kg, All were added into sodium chloride injection to 100 ml, intravenous infusion was continued at the rate of 2 ml/h for 48 h. The value of Ramsay scores and VAS scores were recorded in 1, 6, 12, 24, 36 and 48 h after surgery. The quality of sleep was recorded on the 1st to 3rd night after surgery. The rate of postoperative delirium was evaluated by confusion assessment method (CAM). Also postoperative adverse effects (bradycardia, tachycardia, somnolence, nausea and vomiting and extrapyramidal symptoms) in the two groups were recorded.
Results Compared with group C, the Ramsay scores of group H at 6 h and 12 h after surgery were significantly higher (P < 0.05). The VAS scores of group H decreased significantly at 6 h and 12 h after surgery (P < 0.05). The quality of sleep scores on the 1st and 3rd night were significantly lower than that in group C (P < 0.05). The incidence rate of postoperative delirium was significantly lower (6.7%) than that in group C (30.0%)(P < 0.05). The incidence rate of postoperative nausea and vomiting （PONV）was significantly lower than that in group C (P < 0.05). There was no significant difference of other adverse effects between the two groups.
Conclusion Haloperidol 5 mg added to PCIA is effective in reducing the incidence rate of postoperative delirium in elderly patients undergoing hip replacement surgery and improving postoperative outcome. |
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