右美托咪啶对老年患者非心脏手术后早期认知功能的影响

Effect of Dexmedetomidine on Early Cognitive Function after Non-cardiac Surgery in Elderly Patients

[目的]观察右美托咪定全麻诱导对老年患者非心脏手术后早期认知功能障碍（POCD）的影响。[方法]选择全麻下行择期非心脏手术且年龄≥60岁的老年患者60例（男36例，女24例），随机分为右美托咪定组（A组）和对照组（B组）。两组患者均接受全身麻醉，诱导前分别接受静脉微泵输注右美托咪定（1．0μg／mL）或等量生理盐水，持续输注15min。随后按顺序缓慢静脉推注咪唑安定0．06mg／kg、芬太尼3μg／kg、维库溴铵0．1mg／kg和丙泊酚1～1．5mg／kg实施全身麻醉。术中持续静脉微泵输注丙泊酚2～5mg／（kg·h）和吸入七氟醚0．5％～1．5％，并适时间断追加芬太尼和维库溴铵，维持麻醉深度，观察比较两组各时段简易精神状态检查量表（MMSE）评分。[结果]两组间各时点MMSE评分相比较差异均无显著性（P〉0．05）术后4h两组MMSE评分均较术前显著下降（P〈0．05），但1d后两组患者MMSE评分与术前相比较差异无显著性（P〉0．05）。[结论]右关托咪定可安全地应用于老年患者全身麻醉，不会增加其术后POCD的发生。

[Objective] To observe the effect of dexmedetomidine on early cognition function（POCD） of elderly patients after non-cardiac surgery under general anesthesia. [Methods] Sixty elderly patients over 60 years old（male 26 and female 24） scheduled for selective non-cardiac surgery under general anesthesia were chosen and randomly divided into dexmedetomidine group（group A） and control group（group B）. The patients in two groups received general anesthesia. Before induction, all patients received venous minipump continuous transfusion with dexmedetomidine hydroehloride 1.0μg/mL or isovolume normal saline solution for 15min, and then venous push with midazolam 0. 06mg/kg, fentanyl 30μg/kg, vecuronium bromide 0.1mg/kg and propofol 1- 1.5 mg/kg for general anesthesia in order. During operation, continuous venous minipump transfusion with propofol 2 - 5 mg/（kg·h） and inhalation with 0. 50%- 1.5% sevoflurane were given. Fentanyl and vecuronium were added timely and interruptedly. Anesthesia depth was maintained. Mini-mental state examination（MMSE） at each time point was observed and compared between two groups. [Results] There.was no significant difference in MMSE score at each time point between two groups（ P 〉0. 05）. Compared with before treatment, MMSE score in two groups 4h after operation decreased signif- icantly（ P 〈0.05）. There was no significant difference in MMSE score in two groups between before and ld after operation（ P 〉0. 05）. [Conclusion] Dexmedetomidine can be used safely in general anesthesia of elderly patients, and not increase the incidence of POCD.