Preventive effects of dexmedetomidine on delirium and cognitive impairment after total hip arthroplasty in the elderly

doi:10.3760/cma.j.cn441417-20240903-07029

Abstract

Abstract:

Objective　To analyze the effects of dexmedetomidine on postoperative delirium and cognitive impairment in elderly frailty patients undergoing total hip arthroplasty (THA). Methods　A randomized controlled trial was conducted on 213 elderly frailty patients undergoing elective THA in Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2022 to December 2023, and the patients were divided into 107 cases in the experimental group and 106 cases in the control group using the random number table method. There were 61 males and 46 females in the experimental group, aged (73.11±6.40) years, with a body mass index (BMI) of (23.43±1.43) kg/m², 51 cases on the left side and 56 cases on the right side, American Society of Anesthesiologists (ASA) grade Ⅰ in 35 cases, grade Ⅱ in 47 cases, and grade Ⅲ in 25 cases. There were 64 males and 42 females in the control group, aged (72.91±5.94) years, with a BMI of (23.72±1.20) kg/m², 56 cases on the left side and 50 cases on the right side, ASA grade Ⅰ in 30 cases, grade Ⅱ in 46 cases, and grade Ⅲ in 30 cases. The experimental group was given dexmedetomidine hydrochloride before anesthesia induction, injected with 0.4 μg/kg of load dose within 10 min. After anesthesia induction, dexmedetomidine hydrochloride was injected with 0.4 μg/(kg·h) continuously until the end of the operation. The control group was given the same amount of normal saline before and after anesthesia induction to the end of operation. The incidences of delirium 1-5 d after operation were compared between the two groups (3D-CAM), as well as cognitive function before and 1 d after operation [Mini-Mental State Examination (MMSE)], serum C-reactive protein (CRP) levels before and 1 and 2 d after operation, and incidences of intraoperative bradycardia and hypotension. Independent sample t test, χ² test, and Fisher exact probability method were used for statistical analysis. Results　The total incidence of delirium in the experimental group was lower than that in the control group [9.35% (10/107) vs. 22.64% (24/106)] within 1-5 d after operation (P<0.05). On the first day after operation, the MMSE score of the experimental group was higher than that of the control group [(25.37±2.12) points vs. (24.16±2.33) points] (P<0.05), and the incidence of cognitive dysfunction in the experimental group was lower than that in the control group [9.35% (10/107) vs. 22.64% (24/106)] (P<0.05). One and 2 d after operation, the serum CRP levels in the experimental group were lower than those in the control group [(7.63±1.65) mg/dl vs. (9.45±2.73) mg/dl, (11.85±2.74) mg/dl vs. (14.62±3.15) mg/dl] (both P<0.05). There was no statistically significant difference in the incidence of bradycardia or hypotension between the two groups [24.30% (26/107) vs. 17.92% (19/106), 17.76% (19/107) vs. 15.09% (16/106)] (both P>0.05). Conclusion　Use of dexmedetomidine in elderly frailty patients undergoing THA can reduce the risk of postoperative delirium and cognitive impairment and the level of postoperative CRP, and does not increase the risk of adverse events.

Key words:

Total hip arthroplasty, Dexmedetomidine, Frailty, Delirium, Cognitive impairment

摘要：

目的　分析右美托咪定对老年衰弱患者全髋关节置换术后谵妄和认知障碍的影响。方法　本研究为随机对照试验。选取2022年1月至2023年12月西安交通大学附属红会医院收治的213例择期行全髋关节置换术的老年衰弱患者作为研究对象。采用随机数字表法将患者分为试验组（107例）和对照组（106例）。试验组男61例，女46例；年龄（73.11±6.40）岁；体重指数（23.43±1.43）kg/m²；患髋位置：左51例，右56例；美国麻醉医师协会（ASA）分级：Ⅰ级35例，Ⅱ级47例，Ⅲ级25例。对照组男64例，女42例；年龄（72.91±5.94）岁；体重指数（23.72±1.20）kg/m²；患髋位置：左56例，右50例；ASA分级：Ⅰ级30例，Ⅱ级46例，Ⅲ级30例。试验组麻醉诱导前给予右美托咪定，0.4 μg/kg负荷剂量10 min内泵入完毕，麻醉诱导后以0.4 μg/（kg·h）持续泵入右美托咪定至手术结束。对照组在麻醉诱导前、麻醉诱导后至手术结束期间给予等量生理盐水。比较两组术后1～5 d谵妄发生情况［中文版3分钟谵妄诊断量表（3D-CAM）］；术前和术后1 d认知功能情况［简易精神状态量表（MMSE）］；术前和术后1、2 d血清C-反应蛋白（CRP）水平；术中心动过缓和低血压发生情况。采用独立样本t检验、χ²检验和Fisher确切概率法进行统计学分析。结果　术后1～5 d，试验组谵妄总发生率低于对照组［9.35%（10/107）比22.64%（24/106）］（P<0.05）。术后1 d，试验组MMSE评分高于对照组［（25.37±2.12）分比（24.16±2.33）分］（P<0.05）；试验组认知功能障碍发生率低于对照组［9.35%（10/107）比22.64%（24/106）］（P<0.05）。术后1、2 d，试验组血清CRP水平均低于对照组［（7.63±1.65）mg/dl比（9.45±2.73）mg/dl、（11.85±2.74）mg/dl比（14.62±3.15）mg/dl］（均P<0.05）。两组术中心动过缓和低血压发生率比较，差异均无统计学意义［24.30%（26/107）比17.92%（19/106）、17.76%（19/107）比15.09%（16/106）］（均P>0.05）。结论　老年衰弱全髋关节置换术患者给予右美托咪定可降低术后谵妄、认知功能障碍发生率和血清CRP水平，安全性较好。

关键词:

全髋关节置换术, 右美托咪定, 衰弱, 谵妄, 认知功能障碍

Xue Na, Zhao Yuan, Wang Dezhi, Zhang Hui, Song Lei.

Preventive effects of dexmedetomidine on delirium and cognitive impairment after total hip arthroplasty in the elderly [J]. International Medicine and Health Guidance News, 2025, 31(7): 1199-1203.

薛娜赵媛王德智张辉宋雷.

右美托咪定对老年衰弱患者全髋关节置换术后谵妄和认知障碍的影响 [J]. 国际医药卫生导报, 2025, 31(7): 1199-1203.

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