术前应用右美托咪定对老年患者经尿道前列腺电切术后早期认知功能的影响

Effects of dexmedetomidine on early postoperation cognitive function after transurethrue resection of prostate in elderly patients

目的探讨术前应用右美托咪定对老年患者经尿道前列腺电切术后早期认知功能的影响。方法择期拟行经尿道前列腺电切术患者80例，年龄65-80岁，BMI18-25kg／m^2，随机分为右美托咪定组（D组）和生理盐水组（C组），每组40例。D组患者术前15min静脉泵入右美托咪定0．5μg／kg，对照组给予等容量生理盐水。分别记录两组患者气管插管前（T0）、气管插管时（T1）、手术开始时（T2）、手术开始30min时（T3）的MAP、HR，以及手术时间、拔管时间、清醒时间和麻醉药用量，并分别于术前1d和术后3d采用简易智力量表（MMSE）进行神经心理学评估。记录患者的恶心呕吐等不良反应发生情况。结果两组患者的手术时间、拔管时间、清醒时间、麻醉药用量和不良反应发生情况比较差异无统计学意义。D组患者在T1、T2时的MAP明显高于C组（P〈0．05）。两组患者术后3d的MMSE评分均明显低于术前1d（P〈0．05），且D组明显高于C组（P〈0．05）。D组患者的POCD发生率明显低于C组（P〈0．05）。结论术前应用右美托咪定0．5μg／kg可减少经尿道前列腺电切术老年患者早期POCD的发生，患者血压更平稳并且不影响苏醒。

Objective To investigate the effects of dexmedetomidine on early postoperative cognitive dysfunction （POCD） in the elderly patients who underwent transurethrue resection of the prostate with general anesthesia. Methods Eighty patients （65-80 years） and scheduled for elective transurethrue resection of prostate were randomly divided into two groups： 40 patients received intravenous injection of dexmedetomidine 0. 5 μg/kg （group D） and 40 patients received same volume of normal saline （group C） in fifteen minutes before the induction. MAP and HR were recorded before infusion of dexmedetomidine （T0）, intubation （T1）, beginning of the surgery （T2） and 30 rain after surgery （T3）. The time of operation, extubation awakening and drugs dosage were recorded. Cognitive function was assessed on 1 day before operation and on the 3th day after operation using mini mental state examination （MMSE）. The adverse reactions such as nausea and vomit were recorded. Results There was no difference in the time of operation, extubation, awakening, drugs dosage and the incidence of the adverse reactions. Compared with group C,MAP at T1 ,T2 in group D were significantly inereased（P〈0.05）. MMSE scores on the 3th day after operation were lower than 1 day before in both groups, and group D was higher than group C （P〉0. 05）. The incidence of POCD in group D was lower than in group C （P〈 0. 05）. Conclusion Preoperative administration of dexmedetomidine （0.5μg/kg） can decrease the incidence of POCD in the elderly patients undergoing transurethrue resection of prostate.