标题：右美托咪啶与丙泊酚用于老年患者术后谵妄治疗的比较研究

      作者：王贵强，袁 灵，卫茂华，杨盛泉
    （泸州市人民医院重症医学科，四川 泸州 646000）

      卷次： 2014年25卷18期

      【摘要】 目的 探讨右美托咪定和丙泊酚应用于老年术后谵妄患者的治疗效果及安全性。方法 选择术
后发生谵妄的48例老年患者，按随机数字表法分为右美托咪定组(23例)和丙泊酚组(25例)，分别给予右美托咪定
和丙泊酚治疗，根据重症谵妄筛查表(ICDSC)评估治疗效果，并结合Riker镇静和躁动评分(SAS)调整镇静药剂
量，使镇静深度评分控制在2~4分，同时比较两组在 ICU住院天数及副作用的差异。结果 给予右美托咪定与丙
泊酚治疗后，患者的谵妄症状均缓解，两组的 ICDSC评分分别为(1.6±1.0)分和(1.9±0.9)分，两组比较差异无统计
学意义(P>0.05)；右美托咪定组与丙泊酚组的 ICU平均住院天数分别为(2.3±1.0) d和（3.1±1.4）d，两组比较差异
有统计学意义(P<0.05)；在心血管不良事件发生方面，右美托咪定组的低血压发生率为30.4%，明显低于丙泊酚组
的60.0% (P<0.05)；右美托咪定组的心动过缓发生率为17.4%，明显低于丙泊酚组的44.0% (P<0.05)；呼吸抑制的
发生率方面两组比较差异无统计学意义(P>0.05)。结论 右美托咪定与丙泊酚治疗老年术后谵妄均有效，但在
减少副作用方面，右美托咪定具有明显优势，是一种较为理想的 ICU治疗谵妄的药物。

      【关键词】 右美托咪定；丙泊酚；术后谵妄；副作用

      【中图分类号】 R742 【文献标识码】 A 【文章编号】 1003—6350（2014）18—2690—03


Comparison of sedative effect of dexmedetomidine and propofol for postoperative delirium in elderly patients.
WANG Gui-qiang, YUAN Ling, WEI Mao-hua, YANG Sheng-quan.
Intensive Care Unit, Luzhou People's Hospital,
Luzhou 646000, Sichuan, CHINA

【Abstract】 Objective To evaluate the sedative effect and safety of dexmedetomidine and propofol for
postoperative delirium in elderly patients. Methods Forty-eight elderly patients with postoperative delirium (60
years or older) were enrolled and divided into two groups by random number tables. They were treated either with
dexmedetomidine (dexmedetomidine group, 23 cases) or propofol (propofol group, 25 cases). The treatment effect
for delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). The dose of sedation was
titrated to achieve Riker sedation agitation scores of 2 to 4. In the same time, the ICU hospitalization days, the inci-
dence of side-effects such as hypotension, bradycardia, endotracheal intubation were compared in the two groups.
Results The symptoms of delirium were relieved in all patients. There was no significant difference in ICDSC score
between the dexmedetomidine group and the propofol group [(1.6±1.0) vs (1.9±0.9), P>0.05]. Compared to propofol
group, the ICU hospitalization days in dexmedetomidine group were significantly shorter [(2.3±1.0) d vs (3.1±1.4) d,
P<0.05], the rates of hypotension were significantly lower (30.4% vs 60.0%, P<0.05), and the rates of bradycardian
were significantly lower (17.4% vs 44.0%, P<0.05), but there was no significant difference in the rates of endotracheal
intubation. Conclusion Dexmedetomidine and propofol are both effective in the treatment of postoperative delirium
in elderly patient, but dexmedetomidine results in less side effects and shorter ICU hospitalization days, which is an
preferred sedative for postoperative delirium in ICU.

      【Key words】 Dexmedetomidine; Propofol; Postoperative delirium; Side effect
·论 著·