摘要
目的探究不同剂量右美托咪定(Dex)对接受口腔颌面部手术的老年患者认知功能的影响。方法选取2018年6月至2019年9月于我院择期行口腔颌面部手术的老年患者195例,经过简单随机抽样双盲法将纳入者分为D1组(Dex 0.4μg/kg,n=47)、D2组(Dex 0.6μg/kg,n=49)、D3组(Dex 0.8μg/kg,n=48)和生理盐水对照组(NS组,n=51)。比较4组术前、术中、术后监测指标,S100蛋白和神经元特异性烯醇化酶(NSE),并采用手术应激指数(SSI)及简易精神状态检查量表(MMSE)评定患者认知功能,同时采用酶联免疫吸附(ELISA)测定S100蛋白和神经元特异性烯醇化酶(NSE)。结果 D1组、D2组、D3组用药后需吸引口腔内分泌物次数较NS组明显偏少(P<0.05)。4组术后24h SSI评分、S100蛋白及NSE水平较术前均显著升高,但D2组显著低于其他3组(P<0.05)。4组术后24h MMSE评分较术前均显著降低,但D2组显著高于其他3组(P<0.05)。结论麻醉诱导前应用中剂量(0.6μg/kg)Dex,可有效抑制口腔腺体分泌,对老年患者心肺系统影响较小,同时亦能够明显抑制NSE和S100β蛋白水平的升高,发挥脑保护效应和镇痛效果,对老年口腔颌面部手术患者认知功能影响较小,是此类患者理想的术前用药。
Objective To investigate the effects of different doses of dexmedetomidine(Dex)on cognitive function in elderly patients undergoing oral and maxillofacial surgery.Methods A total of 195 elderly patients who underwent elective oral and maxillofacial surgery were selected.The patients were divided into D1 group(Dex 0.4μg/kg,n=47),D2 group(Dex 0.6μg/kg,n=49),D3 group(Dex 0.8μg/kg,n=48),and saline control group(NS group,n=51).Preoperative,intraoperative,and postoperative monitoring indicators,S100 protein,and neuron-specific enolase(NSE)were compared among the four groups.Surgical stress index(SSI)and simple mental state examination scale(MMSE)were used to assess the patient's perception.S100 protein and neuron-specific enolase(NSE)were measured by enzyme-linked immunosorbent assay(ELISA).Results The D1,D2,and D3 groups needed less oral suction than the control.The SSI score,S100 protein,and NSE levels of the 4 groups post operation were significantly higher than those before operation,but the D2 group was significantly lower than the other 3 groups(P<0.05).The MMSE scores of the 4 groups were significantly lower than those before the operation.But the D2 group was significantly higher than the other 3 groups(P<0.05).Conclusion Before anesthesia induction,moderate dose(0.6μg/kg)DEX can significantly inhibit the NSE and S100βprotein levels and have little effect on the cognitive function of elderly patients undergoing oral and maxillofacial surgery.
作者
韩晓菲
潘楚雄
张晓彤
曹静
HAN Xiao-fei;PAN Chu-xiong;ZHANG Xiao-tong;CAO Jing(Department of Aneasthesia,Capital Medical University School of Stomatology,Beijing 100050,China)
出处
《北京口腔医学》
CAS
2020年第4期220-224,共5页
Beijing Journal of Stomatology
关键词
右美托咪定
剂量
手术
老年患者
认知功能
Dexmedetomidine
Dosage
Sergery
Elderly patients
Cognitive function