1、不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響摘要：目的：右美托咪定是 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults0.html t resultFrame 一種高性能a2腎上腺素能受體激動劑，我們通過采用控制給藥劑量，改善患者對麻醉類藥物的依賴程度，

2、從而來減少麻醉藥的用藥劑量。右美托咪定通過激動神經(jīng)系統(tǒng)及a2受體，對患者疼痛部位進行改善，減少患者應(yīng)激反應(yīng)的產(chǎn)生。經(jīng)臨床 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults2.html t resultFrame 研究發(fā)現(xiàn)，右美托咪定對于炎癥的產(chǎn)生具有一定的抑制作用。本文將60至80歲的老年骨病

3、患者最為研究對象，旨在探討右美托咪定在腰-硬聯(lián)合麻醉老年骨科手術(shù)中的應(yīng)用，旨在研究右美托咪定對于血液流動學(xué)，圍術(shù)期用藥、炎癥的發(fā)生及老年患者術(shù)后認知功能的影響作用。 方法：將60至80歲接受腰-硬聯(lián)合麻醉老年骨科手術(shù)的36例患者作為本次研究對象，將患者隨機分為兩組，分別為右美托咪定鎮(zhèn)靜組和對照組，其中右美托咪定鎮(zhèn)靜組按照右美托咪定劑量的不同分為三個組別（D1、D1、D3），劑量分別為 0.3g/kg/h、0.5g/kg/h、0.7g/kg/h。每組患者人數(shù)為9例。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTe

4、mpPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults5.html t resultFrame 右美托咪定鎮(zhèn)靜組患者均在麻醉誘導(dǎo)后按照1. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認

5、知功能的影響文檔檢測報告_PaperRstaticresults6.html t resultFrame 0g/kg的標準給予患者，注射時長為15分鐘，注射結(jié)束后分別按照0.3g/kg/h、0.5g/kg/h、0.7g/kg/h標準給予D1、D2、D3組患者持續(xù)微量泵泵注右美托咪定，直到手術(shù)結(jié)束。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影

6、響文檔檢測報告_PaperRstaticresults8.html t resultFrame 對照組患者則用微量泵持續(xù)泵入等容量0.9%氯化鈉注射液。所有患者的麻醉方式均為腰-硬聯(lián)合麻醉，取患者要不2-3間隙行腰-硬聯(lián)合麻醉，麻醉成功后，在10分鐘內(nèi)將右美托咪定藥劑勻速泵入到患者體內(nèi)，同時調(diào)節(jié)丙泊酚等輔助麻醉藥劑的輸注速度，將丙泊酚的輸注速度控制在555的范圍之內(nèi)，使用規(guī)格為0.040. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時

7、目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults10.html t resultFrame 05mg/kg的咪唑安定以及規(guī)格為46g/kg的芬太尼，配合使用規(guī)格為0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRst

8、aticresults11.html t resultFrame 1mg/kg的維庫溴銨及規(guī)格為0.51mg/kg的丙泊酚。手術(shù)前一階段，根據(jù)患者麻醉感受適當追加芬太尼，隨后再依據(jù)患者對麻醉劑的需求量來持續(xù)泵入丙泊酚，以此來維持患者的鎮(zhèn)靜，同時使用芬太尼來止痛。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstat

9、icresults13.html t resultFrame 根據(jù)需要注射維庫溴銨，使患者肌肉處于松弛狀態(tài)。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults14.html t resultFrame 手術(shù)過程中聽覺誘發(fā)電位指數(shù)的標準為3040. HYPERLINK file:/C:Docum

10、ents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults15.html t resultFrame 分別在患者手術(shù)前，手術(shù)結(jié)束，術(shù)后24小時抽血。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20

11、的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults16.html t resultFrame 并測定血漿中指標濃度。使用國際公認的符合Z分法對患者的術(shù)后認知功能進行測定，將國際公認的術(shù)后認知障礙認定標準作為本次研究診斷標準。這一標準的具體算法是：另外找尋26名身體健康且與本次試驗?zāi)挲g相仿的老年人作為對比組，使用簡易智能精神狀態(tài)檢查量表和韋氏成人記憶量表以及智力量表對這26位老人的認知功能進行初步測評，計算并統(tǒng)計每個單項測評項目的得分，并計算平均值（均數(shù)標準差），接下來，計算本次研究的36例老

12、年骨病患者在手術(shù)前和手術(shù)后各項精神測評分數(shù)的數(shù)學(xué)差值，用這些數(shù)學(xué)差值與S值相除，所得結(jié)果就是每個個體測試的Z值，Z的值越大則說明，患者在手術(shù)前后精神功能落差較大，術(shù)后認知功能出現(xiàn)了明顯下降。最后將每個個體的Z值相加，所得數(shù)字就是復(fù)合Z分，若八項測試復(fù)合分數(shù)在1. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstat

13、icresults20.html t resultFrame 96以上或有兩項分數(shù)高于1. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults21.html t resultFrame 96，則認定該患者患有術(shù)后認知功能障礙。 結(jié)果：1. HYPERLINK file:/C:Documents%

14、20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults22.html t resultFrame 四組患者手術(shù)前及手術(shù)后一般情況對比，未出現(xiàn)統(tǒng)計學(xué)差異。2.右美托咪定鎮(zhèn)靜組D1組出現(xiàn)術(shù)后認知功能障礙5例，占據(jù)研究比例的55.56%；D2組出現(xiàn)術(shù)后功能障礙患者3例，占據(jù)研究比例的33.33%。D3組出現(xiàn)術(shù)后功能障礙患者1例，占據(jù)研究比例的11.11%。隨著

15、右美托咪定計量的增加，三組患者中認知功能障礙的發(fā)生幾率依次減少，但不具備統(tǒng)計學(xué)意義。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults27.html t resultFrame 對照組出現(xiàn)術(shù)后功能障礙患者7例，比例為77. HYPERLINK file:/C:Documents%20and%2

16、0SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults28.html t resultFrame 78%，相對于右美托咪定鎮(zhèn)靜組患者，術(shù)后功能障礙發(fā)生率明顯增多，具備統(tǒng)計學(xué)意義。3. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545

17、.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults29.html t resultFrame 比較四組病例手術(shù)過程中芬太尼的用量可知：對照組患者的用量為0.760.12mg，D1組用量為0.680.11mg，D2組用量為0.60.14mg,D3組用量為0.540.14mg。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時

18、目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults30.html t resultFrame HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults33.html t resultFrame 美托咪定鎮(zhèn)

19、靜組芬太尼的用量較對照組而言，明顯減少，具備統(tǒng)計學(xué)意義。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults31.html t resultFrame 對比四組患者手術(shù)中瑞芬太尼的用量，可知，對照組患者的用量為1.260.52mg，D1組用量為0.980.61mg，D2組用量為0.830.15m

20、g,D3組用量為0.610.57mg。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults32.html t resultFrame 右美托咪定鎮(zhèn)靜組瑞芬太尼的用量較對照組而言，明顯減少，具備統(tǒng)計學(xué)意義。 HYPERLINK file:/C:Documents%20and%20Settingss

21、xlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults30.html t resultFrame HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知

22、功能的影響文檔檢測報告_PaperRstaticresults33.html t resultFrame 美托咪定鎮(zhèn)靜組芬太尼的用量較對照組而言，明顯減少，具備統(tǒng)計學(xué)意義。對比四組患者手術(shù)中丙泊酚的用量，可知，對照組患者的用量為783.21268.52mg，D1組用量為512.32231.81mg，D2組用量為501.72231.19mg,D3組用量為421.71248.51mg。 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%2

23、05不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults35.html t resultFrame 右美托咪定鎮(zhèn)靜組丙泊酚的用量較對照組而言，用量明顯減少，具備統(tǒng)計學(xué)意義。4.從 HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstat

24、icresults36.html t resultFrame 四組患者不同時間心率統(tǒng)計比較可知，F(xiàn)=32. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults37.html t resultFrame 73，右美托咪定組患者和對照組患者相比，不存在統(tǒng)計學(xué)差異。5. HYPERLINK file:

25、/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults38.html t resultFrame 四組患者在手術(shù)開始前即T1時間點，手術(shù)結(jié)束即T2時間點內(nèi)的外周血血漿中的IL-6水平的組間比較沒有統(tǒng)計學(xué)差異，但當患者接受手術(shù)后24小時即T3時間點時，右美托咪定組患者的IL-6水平相對于對照組而言具有顯著差異，且相對比具有統(tǒng)計學(xué)研

26、究意義。四組患者在手術(shù)開始前，手術(shù)結(jié)束時，手術(shù)結(jié)束后24小時三個時間點外周血血漿中的腫瘤壞死因子-a水平有所變化，且經(jīng)過對比可知這種變化具備統(tǒng)計學(xué)差異。在相同時間點內(nèi)，四組患者血漿中的NF-KB轉(zhuǎn)錄因子的活性沒有統(tǒng)計學(xué)差異，不能進行科學(xué)對比。6. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresult

27、s38.html t resultFrame 四組患者在手術(shù)開始前即T1時間點，手術(shù)結(jié)束即T2時間點內(nèi)的外周血血漿中的IL-6水平的組間比較沒有統(tǒng)計學(xué)差異，但當患者接受手術(shù)后24小時即T3時間點時，右美托咪定組患者的IL-6水平相對于對照組而言具有顯著差異，且相對比具有統(tǒng)計學(xué)研究意義。四組患者在手術(shù)開始前，手術(shù)結(jié)束時，手術(shù)結(jié)束后24小時三個時間點外周血血漿中的腫瘤壞死因子-a水平有所變化，且經(jīng)過對比可知這種變化具備統(tǒng)計學(xué)差異。在相同時間點內(nèi)，四組患者血漿中的NF-KB轉(zhuǎn)錄因子的活性沒有統(tǒng)計學(xué)差異，不能進行科學(xué)對比。 結(jié)論：1、在腰-硬聯(lián)合麻醉老年骨科手術(shù)中對患者使用右美托咪定可以明顯減少芬太尼

28、、瑞芬太尼、丙泊酚藥劑的用量，并伴隨右美托咪定濃度的增高而呈現(xiàn)遞減趨勢，尤其是使用0.3g/kg/h、0.5g/kg/h、0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults45.html t resultFrame 7g/kg/h的劑量能夠有效控制藥物用量。2.在腰-硬聯(lián)合麻醉老年骨科手術(shù)

29、中對患者使用右美托咪定能夠有效的降低老年術(shù)后認知障礙的發(fā)生幾率。 關(guān)鍵詞：右美托咪定；腰-硬聯(lián)合麻醉；老年骨科；手術(shù)；認知功能障礙； Abstract Objective: Dexmedetomidine is a high performance A2 adrenergic receptor agonist, can control through the dose dependent effect to improve patients for anesthesia drugs is very good, can greatly reduce the use of narcotic dru

30、gs. Dexmedetomidine through the nervous system and A2 receptor, to improve patient pain position, reduce the stress response in patients. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_Pape

31、rRstaticresults49.html t resultFrame The study found, dexmedetomidine has inhibiting effect on the production of inflammatory. This paper will be the research object for 60 to 80 year old bone disease patients, to investigate the effects of dexmedetomidine on the application of combined spinal - epi

32、dural anesthesia in the elderly Department of orthopedics operation, aims to study the effects of dexmedetomidine on blood rheology, effects of cognitive function in elderly patients with preoperative and perioperative medication, inflammation after. Methods: 36 cases of 60 to 80 years undergoing co

33、mbined spinal epidural anesthesia in elderly patients with Department of orthopedics operation as the object of study, the patients were randomly divided into two groups, respectively, dexmedetomidine sedation group and control group, wherein dexmedetomidine sedation group according to different dex

34、medetomidine dose is three a group (D1, D1, D3), the dose of 0.3 g/kg/h, 0.5 g/kg/h, 0.7 g/kg/h. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults52.html t resultFrame The

35、number of patients in each group is 9 cases. Dexmedetomidine sedation groups of patients after anesthesia induction in 1 mu g/kg standard to give patients, injection duration is 15 minutes, after the end of the injection respectively according to the 0.3 g/kg/h, 0.5 g/kg/h, 0.7 g/kg/h standard to tr

36、ace pump infusion of dexmedetomidine continuous D1, D2, D3 groups of patients, until the end of operation. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults55.html t result

37、Frame The control group patients with trace pump continuous pump into the volume of 0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults56.html t resultFrame 9% Sodium Chlo

38、ride Injection. Anesthesia of all patients were combined spinal epidural anesthesia, taken from the patient or 2-3 clearance for combined spinal epidural anesthesia, after successful anesthesia, dexmedetomidine agents will be uniform pump into the body of a patient in 10 minutes, while regulating th

39、e propofol injection speed transmission such as auxiliary anesthesia, the infusion speed control in 55 + 5 within the scope of the use of propofol, midazolam specifications for 0.04 - 0.05mg/kg and specifications for the 4 - 6 g/kg fentanyl, vecuronium and specifications with the use of specificatio

40、n for 0.1mg/kg 0.5 - 1mg/kg of propofol. A stage before operation, patients feel fentanyl anesthesia according to appropriate, then based on the demand of the patients continued to pump into the anesthetic propofol, in order to maintain patient sedation, while using Fentainilai pain. HYPERLINK file:

41、/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults61.html t resultFrame According to the need of injection of vecuronium, make the patient muscles in a relaxed state. HYPERLINK file:/C:Doc

42、uments%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults62.html t resultFrame Operation process of auditory evoked potential index standards for 30 - 40 respectively in the patients before operation,

43、the end of the operation, 24 hours after the blood. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults63.html t resultFrame Determination of plasma concentration and index.

44、The use of internationally accepted compliance on the determination of cognitive function in patients with postoperative Z score, the internationally recognized postoperative cognitive impairment recognized standards as the research diagnostic criteria. The specific algorithm of this standard is: fi

45、nd another 26 healthy and the test of similar age elderly people as contrast group, using the mini mental state examination scale and the Wechsler Adult Intelligence Scale memory scale and the cognitive function of the 26 old mens preliminary assessment, calculation and statistics of each individual

46、 assessment item score, and calculate the mean (standard deviation), then, the mathematical difference between the 36 cases of senile patients with bone disease and calculated in this study the operation before and after operation of mental test scores, using these mathematical difference and S valu

47、es, the results is that each individual test Z value, Z value the greater the instructions, patients in the gap between the larger mental function before and after operation, postoperative cognitive function declined. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_2014

48、1231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults66.html t resultFrame At the end of each individual Z values, income numbers are composite Z, if the eight test composite score above 1. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempP

49、aperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults67.html t resultFrame 96 or two scores above 1. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)

50、后認知功能的影響文檔檢測報告_PaperRstaticresults68.html t resultFrame 96, identify the patients with postoperative cognitive dysfunction. Results: compared with the general situation of 1 patients in the four groups before and after operation, no significant difference. 2 dexmedetomidine sedation group D1 group,

51、postoperative cognitive dysfunction in 5 cases, occupy on proportion of 55.56%; HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults71.html t resultFrame D2 group of 3 cases o

52、f dysfunction of patients with postoperative, occupy 33. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults72.html t resultFrame 33% of the proportion of the research. HYPER

53、LINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults73.html t resultFrame D3 group, dysfunction of patients with postoperative 1 cases, occupy the 11.11% of proportion. With the in

54、crease of dexmedetomidine measurement, probability of cognitive dysfunction in three groups decreased, but did not reach statistical significance. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔

55、檢測報告_PaperRstaticresults76.html t resultFrame The control group had 7 cases of dysfunction of patients after operation, the ratio was 77.78%, compared with dexmedetomidine sedation group of patients, postoperative dysfunction rate increased, with statistical significance. 3 Comparison of dosage fent

56、anyl group four cases of operation in the process of knowable: patients in the control group with dosage of 0.76 + 0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults79.ht

57、ml t resultFrame 12mg, D1 dosage is 0.68 + 0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults80.html t resultFrame 11mg group, D2 group with dosage of 0.6 + 0. HYPERLINK

58、file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults81.html t resultFrame 14mg, D3 group with dosage of 0.54 + 0.14mg. Medetomidine sedation group compared with the control group, the d

59、osage of fentanyl, significantly reduced, with statistical significance. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults83.html t resultFrame Remifentanil compared four g

60、roups of patients with operation in the amount of, know, patients in the control group with dosage of 1.26 + 0. HYPERLINK file:/C:Documents%20and%20SettingssxlLocal%20SettingsTempPaperRater_20141231_985545.zip%20的臨時目錄%205不同劑量右美托咪定對腰-硬聯(lián)合麻醉老年骨科手術(shù)患者術(shù)中的臨床應(yīng)用及術(shù)后認知功能的影響文檔檢測報告_PaperRstaticresults84.html t r