右美托咪定对静吸复合麻醉下老年胸科手术患者术后认知功能的影响

Effect of Dexmedetomidine on the Postoperative Cognitive Function of Elderly Patients Underwent Thoracic Surgery with Intravenous Combined with Inhalation Anesthesia

目的探讨右美托咪定对静吸复合麻醉下老年胸科手术患者术后认知功能的影响。方法选择80例于该院实施胸科手术的老年患者作为研究对象,随机分为复合组和对照组,每组40例。对照组采用七氟醚静吸复合全身麻醉,复合组在对照组基础上复合右美托咪定。监测两组患者的BIS值及七氟醚用量,记录两组患者术毕恢复呼吸时间、呼之睁眼时间及拔管时间。采用简易智力状态检查表(MMSE)评价患者麻醉前、术后1、6、12、24、48 h的认知功能状态,并于术后1、6、24 h检测患者血S100β水平。结果两组患者手术时间、出血量、术毕恢复呼吸时间、呼之睁眼时间及拔管时间差异无统计学意义。复合组术后1 h、术后6 h、术后12 h的MMSE评分分别为(24.5±1.4)、(27.1±1.2)、(28.0±1.1)分,术后1 h、6 h的血S100β蛋白分别为(0.093±0.021)、(0.069±0.015)μg/L,单位七氟醚用量为(17.7±2.2)mL/h;对照组术后1 h、术后6 h、术后12 h的MMSE评分分别为(22.1±1.8)、(25.7±1.0)、(27.0±1.3)分,术后1 h、6 h的血S100β蛋白分别为(1.434±0.036)、(1.175±0.040)μg/L,单位七氟醚用量为(25.3±2.0)mL/h,差异有统计学意义。结论右美托咪定可减少静吸复合麻醉下老年胸科手术患者术后认知功能障碍的发生,复合右美托咪定可减少七氟醚在老年胸科手术中的用量。

Objective To investigate the effect of dexmedetomidine on the postoperative cognitive function of elderly patients underwent thoracic surgery with intravenous combined with inhalation anesthesia. Methods 80 elderly patients underwent thoracic surgery in our hospital were selected as the research subjects and randomly divided into the combined group and the control group with 40 patients in each. The control group was given sevoflurane intravenous combined with inhalation anesthesia, and the combined group was given dexmedetomidine on the basis of the anesthesia of the control group. The value of BIS and sevoflurane consumption of two groups were monitored. The time to respiration recovery, duration of opening eyes on verbal command, extubation time after the surgery of the two groups of patients were recorded. Mini-mental State Examination（MMSE） was used to evaluate the cognitive function state of the patients 1h, 6h, 12 h, 24 h, 48 h after the operation, and serum S100β levels of the patients 1h, 6h,24 h after the operation were detected. Results There were no statistically significant differences in the duration of operation, the amount of bleeding, time to respiration recovery, duration of opening eyes on verbal command, extubation time between the two groups of patients. The MMSE scores of the combined group 1h, 6h, 12 h after the operation were（24.5±1.4）,（27.1±1.2）,（28.0±1.1）points, respectively, and those of the control group were（22.1 ±1.8）,（25.7 ±1.0）,（27.0 ±1.3） points, respectively; the serum S100βprotein of the combined group 1h, 6h after the operation was（0.093 ±0.021）,（0.069±0.015）μg/L, and that of the control group was（1.434±0.036）,（1.175±0.040）μg/L, respectively; the dosage of sevoflurane used in the combined group was（17.7 ±2.2）ml/h, and that used in the control group was（25.3±2.0）ml/h, the differences were statistically significant. Conclusion Dexmedetomidine may reduce the incidence of POCD in elderly patients with thoracic surgery under intravenous combined with inhalation anesthesia, composite dexmedetomidine can reduce the consumption of sevoflurane in elderly thoracic surgery.