右美托咪定对老年胃肠肿瘤根治术围术期脑氧代谢及术后认知功能的影响

Effects of Dexmedetomidine on Perioperative Cerebral Oxygen Metabolism and Postoperative Cognitive Function in Elderly Patients Undergoing Radical Operation for Gastrointestinal Cancer

目的评价右美托咪定对老年胃肠肿瘤根治术患者围术期脑氧代谢及术后认知功能的影响。方法选择择期全身麻醉下行胃肠肿瘤根治术患者60例,ASAⅠ-Ⅲ级,采用随机数字表法将其分为2组:右美托咪啶组(D组)30例麻醉诱导前经20min静脉输注右美托咪定0.5μg·kg-1,随后以0.3μg·kg-1·h-1速度输注至术毕前,生理盐水对照组(C组)30例以同样方法静脉输注等容量生理盐水。分别于麻醉诱导前(T0)、气管插管后即刻(T1)、气管插管后10min(T2)及手术结束时(T3)经桡动脉和颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)。分别于术前访视时,术后6h、1d、2d及3d对患者进行简易精神状态检查量表(MMSE)评分。结果 1)与T0时点相比,T1—T3时点2组Da-jvO2及CERO2均显著降低(P<0.05);与C组相比,D组T2—T3时点Da-jvO2及CERO2均显著降低(P<0.05)。2)与术前比较,C组术后各时点MMSE评分均显著降低(P<0.05),D组术后6h及1dMMSE评分显著降低(P<0.05);与C组比较,D组术后各时点MMSE评分均显著升高(P<0.05)。结论右美托咪定可降低老年胃肠肿瘤根治术患者围术期脑氧代谢,从而改善术后认知功能。

Objective To investigate the effects of dexmedetomidine on perioperative cerebral oxygen metabolism and postoperative cognitive function in elderly patients undergoing radical op-eration for gastrointestinal cancer.Methods Sixty ASA Ⅰ-Ⅲ elderly patients undergoing radical operation for gastrointestinal cancer were randomly divided into two groups,with 30 patients in each group.Patients in group D were given intravenous infusion of 0.5 μg·kg-1 dexmedetomi-dine 20 minutes before operation,followed by intravenous infusion of dexmedetomidine at a rate of 0.3 μg·kg-1 ·h-1 our until the end of operation.Patients in group C was given the equal vol-ume of normal saline.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis before induction of anesthesia（T0 ）,immediately after tracheal intubation（T1 ）,10 mi-nutes after tracheal intubation（T2 ）and at the end of operation（T3 ）.Cerebral A-VO2 content differences（Da-jvO2 ）and cerebral O2 extraction rate（CERO2 ）were calculated at the same time.＆amp;nbsp;The mini-mental state examination（MMSE）score was recorded at preoperative visit and 6 hours and 1,2 and 3 days after operation.Results Compared with T0 ,both Da-jvO2 and CERO2 de-creased at T1-T3 in both groups（P 〈0.05）.Compared with group C,both Da-jvO2 and CERO2 de-creased in group D at T2-T3 （P 〈0.05）.Compared with preoperative score,MMSE score decreased at all postoperative time points in group C,as well as at 6 hours and 1 day after operation（P 〈0.05）.Compared with group C,MMSE score increased at all postoperative time points in group D （P 〈0.05）.Conclusion Dexmedetomidine treatment can decrease perioperative cerebral oxygen metabolism and thus improve postoperative cognitive function in elderly patients undergoing radi-cal operation for gastrointestinal cancer.