右美托咪定对老年腹腔镜手术患者术后认知功能的影响

Effects of dexmedetomidine on postoperative cognitive dysfunetion in the aged patients undergoing laparoscopic surgery

目的：探讨右美托咪定对老年腹腔镜手术者术后认知功能障碍（POCD）及炎性因子影响。方法：选择老年腹腔镜手术患者40例（ASAⅡ~Ⅲ,65~85岁）,随机分为DXM组、对照组（C组）,每组20例。DXM组麻醉前静脉推注右美托咪定0.5μg/kg,以0.5μg/（kg·h）维持至手术结束前30 min,C组应用生理盐水,于术前1天（T0）、术后24 h（T1）、48 h（T2）、72 h（T3）测血清IL-6、TNF-α浓度,进行简易智能量表评分（MMSE）及视觉模拟评分（VAS）。结果：T1~3时MMSE评分较T0降低,DXM组T1~2时高于C组,其术后72 h POCD发生率低于C组,术后24 h C组VAS评分高于DXM组（P〈0.05）;T1~2时血清IL-6、TNF-α水平高于术前,DXM组低于C组（P〈0.05）。结论：右美托咪定能缓解老年腹腔镜手术患者术后早期认知功能障碍,下调血清IL-6和TNF-α表达。

Objective To study the Effects of dexmedetomidine on postoperative cognitive dysfunction and expressions of interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α） in aged patients undergoing laparoscopic surgery.Methods A total of 40 elderly patients（ASA Ⅱ~Ⅲ,65~85 years） scheduled for selective laparoscopic surgery were randomly divided into two groups：treated group（group DXM） and control group（group C）,with 20 patients in each group.The patients of group DXM received intravenous dexmedetomidine 0.5 μg/kg,and maintaind with 0.5 μg/（kg·h） during the operation until 30 mins before the end of operation,and the control group just received the normal saline.Blood samples were collected from the patients 1 day before operation（T0） and 24 hours（T1）,48 hours（T2）,72 hours（T3） after the surgery for the determination of serum IL-6,TNF-α concentration.Analgesic efficacy was assessed after surgery based on visual analog scales（VAS）.The cognitive function of the patients was assessed by mini-mental state examination（MMSE） at the time points above.Results At the time points of T1~3,the MMSE scores in the two groups were all lower than the baseline,however,the MMSE scores in group DXM were higher than the control group at T1 and T2 time points;At 72 hours after surgery,the incidence of POCD in group DXM was significantly lower than that in group C.The VAS of group DXM at 24 hours after surgery was significantly lower than that of group C（P〈0.05）.The serum IL-6 and TNF-α concertrations of the patients in the two groups were significantly higher than the baseline at the time points of T1~2,and which were significantly lower in group DXM than the control group（P〈0.05）.Conclusion Dexmedetomidine can obviously alleviate the occurance of the early POCD in the aged patients with laparoscopic surgery,and the mechanisms may be related to down-regulation of IL-6 and TNF-α expression.