右美托咪定对老年患者经尿道前列腺电切术后早期认知功能的影响

Effects of dexmedetomidine on early postoperative cognitive function after transurethral resection of the prostate in elderly patients

目的：探讨右美托咪定（Dex）对老年患者经尿道前列腺电切术（TURP）早期认知功能的影响.方法：择期拟行TURP患者76例,美国麻醉师协会（ASA）分级Ⅰ或Ⅱ级,年龄65～81岁,术前简易智力状态检查量表（MMSE）评分＞23分,采用随机数字表法,将其随机分为2组：Dex组（D组）和生理盐水组（C组）,每组38例.全麻诱导前D组静脉输注负荷量Dex 1μg/kg,10 min后改为恒速静脉输注Dex 0.5 μg＆#183;kg-1＆#183;h-1至术毕前30 min,C组采用同样方法静脉输注等容量生理盐水.记录气管插管前（T0）、气管插管即刻（T1）、手术开始时（T2）、手术开始30 min（T3）时的MAP和HR以及手术时间、苏醒时间,并分别于术前24 h、术后24 h采用MMSE评分进行神经心理学评估.结果：两组患者一般资料和术中情况比较差异无统计学意义.C组患者在T1、Tz时的MAP明显高于D组（P＜0.05）.与C组比较,D组术后24 h的MMSE评分明显升高,术后认知功能障碍（POCD）的发生率明显降低（P＜0.05）.结论：Dex可减少老年患者TURP术后早期POCD的发生率,术中麻醉平稳且不影响患者的苏醒.

AIM：To investigate the effect of dexmedetomidine on early postoperative cognitive dysfunction（POCD）in elderly patients who underwent transurethral resection of the prostate （TURP）.METHODS：Seventy-six ASA grade Ⅰ or Ⅱ patients and mimi mental state exam （MMSE） score〉23,aged 65-81 y,scheduled for elective for TURP were enrolled and randomly divided into 2 groups （n=38 each）：Dex group （group D） and control group （group C）.Dex 1 μg/kg was infused intravenously over 10 min before anesthesia induction,and then infused at a rate of 0.5 μg· kg^-1 · h^-1 until 30 min before the end of the operation in group D.Group C received the equal volume of normal saline with same way.MAP and HR were recorded before intubation （T0）,intubation （T1）,beginning of the surgery （T2） and 30 min after surgery （T3）.The time of operation and awakening were recorded.Cognitive function was assessed at 24 h before and after operation using MMSE.RESULTS：There were no significant differences of general information and parameters in operation was not statistically significant between the two groups （P〉0.05）.Compared with group D,MAP at T1,T2 in group C were significantly increased （P 〈 0.05）.MMSE scores at 24 h after operation were higher in group D and the incidence of POCD was lower than group C （P〈0.05）.CONCLUSION：Dex can decrease the incidence of early POCD in elderly patients undergoing TURP,hemodynamic parameters is steady and does not affect awakening of patients.