亚麻醉剂量氯胺酮与负荷剂量右美托咪定对老年人腹腔镜术后认知功能障碍的影响

Influence of subanesthetic dose Ketamine and loading dose Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients

目的观察亚麻醉剂量氯胺酮与负荷剂量的右美托咪定对老年人腹腔镜手术患者早期术后认知功能障碍（POCD）的影响。方法选择广东省中山市人民医院2014年4～9月,年龄60～80岁行腹腔镜手术老年患者90例。数字随机表法分为三组：对照组（C组）、右美托咪定组（D组）、氯胺酮组（K组）。三组均行气管插管全身麻醉。D组在诱导前给予0.5μg/kg右美托咪定,K组诱导前给予0.5 mg/kg氯胺酮,C组给予相同容量的0.9%氯化钠注射液。三组患者行术前1 d,术后1、2、3 d的简易智力状态检查法（MMSE）评分,计算POCD的发生率。结果 1与术前1 d比较,C组和D组术后1、2 d的MMSE评分明显下降,差异有统计学意义（P〈0.05）;与K组比较,C组和D组术后1、2 d的MMSE评分明显下降,差异有统计学意义（P〈0.05）。2与C组比较,K组术后1、2 d的POCD发生率降低,差异有高度统计学意义（P〈0.01）。结论亚麻醉剂量的氯胺酮对术后认知功能具有保护作用,能降低腹腔镜老年患者早期POCD的发生率,负荷剂量的右美托咪定不能降低腹腔镜老年患者POCD的发生率。

Objective To observe the influence of subanesthetic dose Ketamine and loading dose Dexmedetomidine（Dex） on postoperative cognitive dysfunction（POCD） in the elderly patients. Methods 90 patients（60-80 years） with laparoscopic surgery in People′s Hospital of Zhongshan City from April to Septmber 2014 were randomly divided into three group： Dex group（group D）, Ketamine group（group K）, control group（group C）. All patients were received general anesthesia. Before the induction of general anesthesia, the patients in group D were received 0.5 μg/kg Dex. The patients in group K were received 0.5 mg/kg Ketamine. The patients in group C were received the same volume saline.Mini-mental state examination（MMSE） was used to assess the cognitive function 1 d before the operation and 1, 2, 3 d after the operation. The incidences of POCD were calculated. Results 1Compared with 1 d before surgery, the MMSE score 1, 2 d after surgery in group C and group D significently decreased（P〈 0.05）; compared with group K, the MMSE score 1, 2 d after surgery in group C and group D also significantly decreased（P〈 0.05）. 2 Compared with group C, the incidence of POCD 1, 2 d after surgery in group K significantly decreased（P 〈0.01）. Conclusion The results suggest that subanesthetic dose of Ketamine can protect the cognitive function and decrease the incidence of POCD at the earerly stage in elderly patients with laparoscopic surgery. Loading dose Dex can not decrease the incidence of POCD in elderly patients with laparoscopic surgery.