右美托咪定和咪达唑仑对老年患者下肢手术后S100β蛋白和简易智力状态检查法的影响

Effect of dexmedetomidine or midazolam on postoperative S100β and mini-mental state examination under lower limbs surgery in old patients

目的 比较老年患者下肢手术中采用硬膜外阻滞联合运用右美托咪定（dexmedetomidine， Dex）或咪达唑仑镇静对患者术后认知功能的影响。 方法 选择老年骨科下肢手术患者90例，使用电脑分段分组随机分成3组：硬膜外阻滞组（C组）、硬膜外阻滞联合咪达唑仑组（M组）、硬膜外阻滞联合Dex组（D组），每组30例。分别在术前 1 d、术后 1、3 d和7 d采用简易智力状态检查法（mini-mental state examination， MMSE）评估患者认知功能。于术前1 d、手术结束时及术后1 d取静脉血浆检测S100β蛋白和神经元特异性烯醇化酶（neuron？蛳specific enolase， NSE）浓度，评估患者神经系统损伤。 结果 术前各组MMSE评分、血浆S100β蛋白和NSE浓度差异无统计学意义（P〉0.05）。术后1、3 d及7 d ，D组MMSE评分分别为（26.2±3.4），（27.0±3.1），（27.0±3.4），C组MMSE评分分别为（25.0±2.3），（25.3±2.3），（26.0±3.2），M组MMSE评分分别为（25.0±3.1），（25.5±3.2），（26.0±3.4），各组较术前MMSE评分下降，差异有统计学意义（P〈0.05）；M组与C组各时间点评分差异无统计学意义（P〉0.05）；D组较C组及M组各时间点评分高，差异有统计学意义（P〈0.05）。手术结束时和术后1 d，各组较术前血浆S100β蛋白及NSE浓度升高，差异有统计学意义（P〈0.05）。手术结束时，D组血浆S100β蛋白浓度为（0.146±0.020），NSE浓度为（8.0±2.3）， C组血浆S100β蛋白浓度为（0.201±0.031），NSE浓度为（10.1±2.3），M组血浆S100β蛋白浓度为（0.196±0.017），NSE浓度为（10.2±2.0），M组与C组血浆S100β蛋白、NSE浓度差异无统计学意义（P〉0.05）；D组较C组及M组S100β蛋白、NSE浓度低，差异有统计学意义（P〈0.05）。 结论 硬膜外阻滞联合术中Dex镇静可改善老年患者术后早期认知功能。

Objective To investigate the effect of application of dexmedetomidine （Dex） or midazolam in surgery on olders＂ postoperative cognitive function and central nervous. Methods Ninety cases were chosen in elderly patients with lower limbs surgery were randomly divided into epidural anesthesia group （group C）, epidural anesthesia with midazolam group （group M）, epidural anesthesia with Dex group（group D）. All the patients testing with mini mental state examination（MMSE） before surgery 1, 3 d and 7 d after surgery. The concentration of S100β and neuron-specific enolase （NSE） in plasma were measured before surgery at the time of surgery finished 1 d after surgery. Results Before surgery, 3 groups have no obvious difference of MMSE score, S100β and NSE. At the time of 1, 3 d and 7 d after surgery, the MMSE score of group D was（26.2±3.4）, （27.0±3.1）, （27.0±3.4）, the MMSE score of group C was （ 25.0±2.3 ）, （ 25.3±2.3 ）, （26.0±3.2）, the MMSE score of group M was （ 25.0±3.1 ）, （ 25.5±3.2 ）, （26.0±3.4）, compared with that of group C and group M, MMSE score of group D was higher （P〈0.05）. At the time of surgery finished and 1 d after surgery, compared with that of preoperation, the concentration of S100β and NSE in plasma of each group was higher （P〈0.05）. At the end of surgery, for group D, the concentration of S100β was（0.146±0.020）, the concentration of NSE was（8.0±2.3）, for group C, the concentration of S100β was （0.201±0.031）, the concentration of NSE was （10.1±2.3）, for group M, the concentration of S100β was （0.196±0.017）, the concentration of NSE was （10.2±2.0）, the concentration of S100β and NSE in plasma of group D was lower than group C and group M （P〈0.05）. Conclusions Using Dex in epidural anesthesia can improve the cognitive function of olders after surgery.