Abstract:

Objective　To study the effects of dexmedetomidine combined with sevoflurane on recovery quality and cognitive function in elderly patients after total knee arthroplasty (TKA). Methods　A total of 120 elderly TKA patients admitted to Weibei Central Hospital from September 2021 to March 2024 were selected for a prospective study, and were divided into an observation group and a control group with 60 cases in each group according to the random number table method. In the observation group, there were 37 males and 23 females, aged (68.79±6.37) years, 16 cases of grade Ⅰ and 44 cases of grade Ⅱ classified by the American Society of Anesthesiologists (ASA). In the control group, there were 39 males and 21 females, aged (68.44±7.41) years, 17 cases of ASA grade Ⅰ and 43 cases of ASA grade Ⅱ. In the control group, anesthesia was maintained by continuous inhalation of sevoflurane with 1%-2% concentration, and the concentration of sevoflurane was reasonably adjusted according to the patients' bispectral index until 0.5 h before the end of the operation. The observation group was supplemented with dexmedetomidine at 0.5 μg/kg per hour until 0.5 h before the end of the operation. The perioperative conditions, the incidence of agitation during the recovery period, and the change of the Montreal Cognitive Assessment Scale (MoCA) score before and after surgery were compared between the two groups, as well as the adverse reactions. t test and χ² test were used for statistical analysis. Results　The awakening time, spontaneous respiration recovery time, and extubation time in the observation group were (8.95±1.30) min, (10.05±1.27) min, and (12.22±1.67) min, which were shorter than those in the control group [(10.21±1.18) min, (13.16±1.40) min, and (16.95±1.74) min], with statistically significant differences (all P<0.05). The incidence of agitation during the recovery period in the observation group was 5.00% (3/60), which was lower than that in the control group [16.67% (10/60)], with a statistically significant difference (P<0.05). The MoCA scores in the observation group 6 h and 12 h after surgery were (24.61±1.83) and (26.79±1.40) points, which were higher than those in the control group [(23.45±1.57) and (25.68±1.31) points], with statistically significant differences (both P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Dexmedetomidine combined with sevoflurane can improve the recovery quality and reduce cognitive impairment in elderly patients after TKA, which is worthy of clinical promotion.

Key words:

Total knee arthroplasty, Old age, Dexmedetomidine, Sevoflurane, Awakening quality, Cognitive function

摘要：

目的　探讨右美托咪定联合七氟醚对老年全膝关节置换术（TKA）后苏醒质量及认知功能的影响。方法　选取2021年9月至2024年3月渭北中心医院收治的120例老年TKA患者进行前瞻性研究，按照随机数字表法分为观察组、对照组各60例。观察组男37例、女23例，年龄（68.79±6.37）岁，美国麻醉医师协会（ASA）分级Ⅰ级16例、Ⅱ级44例；对照组男39例、女21例，年龄（68.44±7.41）岁，ASA分级Ⅰ级17例、Ⅱ级43例。对照组麻醉维持采用1%～2%浓度的七氟醚持续吸入，根据患者脑电双频指数对七氟醚浓度进行合理调整，直至手术结束前0.5 h。观察组在对照组基础上联用右美托咪定，以每小时0.5 μg/kg持续静脉滴注，直至手术结束前0.5 h。比较两组患者的围手术期情况、苏醒期躁动发生率，手术前后蒙特利尔认知评估量表（MoCA）评分变化，不良反应。采用t检验和χ²检验进行统计学分析。结果　观察组患者的苏醒时间、自主呼吸恢复时间、拔管时间分别为（8.95±1.30）min、（10.05±1.27）min、（12.22±1.67）min，均短于对照组（10.21±1.18）min、（13.16±1.40）min、（16.95±1.74）min，差异均有统计学意义（均P<0.05）。观察组苏醒期躁动发生率为5.00%（3/60），低于对照组的16.67%（10/60），差异有统计学意义（P<0.05）。观察组术后6 h、12 h MoCA评分分别为（24.61±1.83）分、（26.79±1.40）分，均高于对照组的（23.45±1.57）分、（25.68±1.31）分，差异均有统计学意义（均P<0.05）。两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　右美托咪定联合七氟醚可提高老年TKA患者术后苏醒质量，减轻认知功能损伤，值得临床推广。

关键词:

全膝关节置换术, 老年, 右美托咪定, 七氟醚, 苏醒质量, 认知功能