尼莫地平与丁咯地尔对高龄患者腹部手术后认知功能障碍影响

The effect of nimodipine and buflomedil to postoperative cognitive dysfunction of the gerontal patient undergoing operation on abdominal region

目的观察高龄患者腹部手术中使用尼莫地平、丁咯地尔对术后认知功能的影响。方法选择择期行腹部手术高龄患者120例,年龄75～90岁,ASAⅠ～Ⅱ级,随机分为3组,尼莫地平组、丁咯地尔组、对照组,每组各40例。尼莫地平组和丁咯地尔组于麻醉前10min开始分别静脉泵入尼莫地平0.25μg.kg-1.min-1和丁咯地尔6μg.kg-1.min-1,至手术结束停药。记录3组患者在麻醉前(T1)、麻醉诱导后(T2)、术中(T3)和手术结束(T4)时的MAP,HR,SPO2,并记录患者术前1d(D1)、术后1d(D2)、术后3d(D3)和术后5d(D4)简易精神状态量表(MMES)评分。结果3组各时点MAP HR SPO2,并无显著差异(P>0.05)。D2尼莫地平组,丁咯地尔组各项评分均显著高于对照组(P<0.05),且尼莫地平组各项评分显著高于丁咯地尔(P<0.05)。D3和D4),尼莫地平组和丁咯地尔组记忆力、执行力评分仍显著高于对照组(P<0.05),并且尼莫地平组记忆力,执行力仍高于丁咯地尔组(P<0.05)。结论术中使用尼莫地平,丁咯地尔可以改善高龄患者腹部手术术后认知功能,并且尼莫地平更优。

Objective To observe the effect of nimodipine and buflomedil applied in operation to cognitive function of the gerontal patient undergoing operation on abdominal region.Methods One hundred and twenty gerontal patients(ASA I^II) undergoing operation on abdominal region,aged 75~90,were evenly randomized into three groups,nimodipine group,buflomedil group and control group.The patients of group nimodipine and group buflomedil were respectively infused nimodipine 0.25μg.kg-1.min-1 and buflomedil 6μg.kg-1.min-1 in ten minute before anesthesia,and stopped in the end of operation.The MAP,HR,SPO2 of the patients of three groups were recorded in terms of pre-anesthesia(T1),post-anesthesia induction(T2),duration of operation(T3),end of operation(T4).And the cog-nitive function of the patients of three groups were graded by mini-mental state examination(MMSE) in the day pre-operation(D1),the first day(D2),the third day(D3) and the fifth day of post-operation(D4).Results The MAP,HR,SPO2 of the patients of three groups were no significant deviation in all terms(P>0.05).MMSE score of three groups were no significant deviation in the day pre-operation(D1)(P> 0.05).In the first day(D2),the MMSE score of nimodipine group and buflomedil group were significantly more than control group(P< 0.05),and the MMSE score of nimodipine group was significantly more than buflomedil group(P<0.05).In the third day(D3) and the fifth day of post-operation(D4),the memory score and performance score of nimodipine group and buflomedil group were significantly more than control group(P<0.05),and the memory score and performance score of nimodipine group was significantly more than buflomedil group(P<0.05).Conclusion Infused of nimodipine and buflomedil during operation could improve the post-operation cognitive function of the gerontal patient undergoing operation on abdominal region,and nimodipine was better than buflomedil.