盐酸右美托咪定对老年患者术后早期认知功能的影响

Effect of dexmedetomidine hydrochloride on earlier postoperative cognitive dysfunction in elderly patients

目的观察盐酸右美托咪定(DEX)对老年患者术后早期认知功能(POCD)的影响。方法选择择期在全麻下手术的老年患者60例,随机分为2组,观察组(D组)和对照组(C组),每组30例。D组全麻诱导前静脉微泵注DEX 4μg/ml,用量为0.4μg/kg,输注时间10 min;C组以相同方法输注等量0.9%氯化钠溶液。2组分别于术前1 d、术后1 d、术后3 d进行简易精神状态量表(mini-mental state examination,MMSE)评分,并观察记录药物输注时(T0)、输注后5 min(T1)、插管时(T2)、插管后1 min(T3)、插管后5 min(T4)的收缩压(SBP)、舒张压(DBP)及心率(HR)。结果 2组术前MMSE评分比较差异无统计学意义,2组术后各时点评分均低于术前(P<0.05)。术后1 d D组的MMSE评分高于C组(P<0.05),D组和C组术后1 d分别有4例(14.8%)和12例(42.9%)发生认知功能下降,差异有统计学意义(P<0.05);术后3 d分别有3例(11.1%)和5例(17.6%)发生认知功能下降,术后3 d 2组的MMSE评分和认知功能下降发生率均无统计学差异(P>0.05)。D组在T1、T3、T4时间点的SBP、DBP、HR均低于C组(P<0.05)。结论老年患者全麻诱导前预输注DEX对术后早期的认知功能下降有一定的预防作用,且不影响诱导期血流动力学的稳定,方法安全。

Objective To observe the effects of dexmedetomidine on earlier postoperative cognitive function in elderly patients. Methods Sixty elderly patients receiving general anesthesia for selective surgery, were randomly divided into two groups with 30 cases in each group. Patients in observation group were given intravenous injection of 0. 4 μg/kg dexmedetomidine hydrochloride by micro-pump, and the infusion continued for 10 min. The patients in control group received the same amount of 0. 9% sodium chloride solution injection in the same way before the induction of anesthesia. The mini-mental state examination （MMSE）score 1 d before operation, 1 d and 3 d after operation were recorded,and the systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were detected at the beginning of drug infusion （T0）, 5 rain after infusion （ T1 ）, intubation （ T2 ）, 1 rain after intubation （ T3 ） and 5 rain after intubation （ T4 ）. Resulls There was no difference in MMSE score between two groups before operation. The MMSE score in two groups after surgery was significantly lower than that before surgery. One day after operation, the MMSE score in observation group was significantly higher than that in control group and the incidence rate of postoperative cognitive dysfunction（POCD） in observation group was significantly lower than that in group C. But there was no difference in MMSE score and the incidence of cognitive decline between two groups 3 d after operation. There were 4 patients （ 14. 8% ） showing cognitive decline in the observation group and 12 patients （42. 9%） in the control group 1 d after operation, and 3 case （11.1%） in the observation group and 5 cases （ 17. 6%） in the control group 3 d after operation. At T1 , T3, T4 time point, SBP, DBP, and HR were lower in observation group （P〈 0. 05）. Conclusions Infusion of dexmedetomidine before induction of anesthesia has some preventive effect for early postoperative cognitive decline in elderly patients, and does not affect the stability of hemodynamic in induction period and the safety.