右美托咪定与咪达唑仑对老年患者术后血清S100β蛋白水平的影响

The effects of dexmedetomidine vs midazolam on postoperative S100β serum levels in elderly

目的比较右美托咪定与咪达唑仑对老年患者术后血清S100β蛋白水平的影响。方法纳入ASAⅠ~Ⅲ级的拟行非心脏、非神经手术的老年患者200例,随机分为右美托咪定组（D组）和咪达唑仑组（M组）,每组100例。D组在麻醉诱导前经静脉持续泵入右美托咪定0.5μg/kg,泵入时间为10min;M组在麻醉诱导前经静脉缓慢推注咪达唑仑0.05mg/kg,其余麻醉处理相同。于术前及术后采集静脉血,采用ELISA方法测定血清中S100β蛋白水平,并计算S100β蛋白水平升高幅度（△S100β）。于术前1d、术后5~7d、3个月采用简易精神状态评价量表（MMSE）评分测定患者术后认知功能障碍（POCD）。结果最终D组98例,M组100例患者纳入分析。术前两组患者血清S100β蛋白水平差异无统计学意义。术后D组血清S100β蛋白水平低于M组,但差异无统计学意义。术后D组血清△S100β明显低于M组（P〈0.01）;两组术后血清S100β与术后5~7dPOCD发生呈正相关（r=0.370,P〈0.01）。术后5~7d、3个月两组患者POCD发生率差异无统计学意义。结论与咪达唑仑比较,右美托咪定可抑制非神经、非心脏手术老年患者术后S100β蛋白水平升高,但对于由MMSE量表评价的POCD发生率无明显影响。

Objective To investigate S100βserum levels after dexmedetomidine vs midazolam pretreatment in the elderly undergoing the non-cardiac or non-neurosurgery surgery.Methods For the total of two hundred aged patients undergoing the selected non-cardiac or non-neurosurgery surgery with general anesthesia enrolled the study and were randomly allocated into two groups：dexmedetomidine group（group D）and midazolam group（group M）.One hundred patients in group D received a dose of 0.5μg/kg dexmedetomidine intravenous infusion over 10 min before the induction of general anesthesia.Another 100 patients in group M received midazolam 0.05mg/kg intravenously.The anaesthesia managements were similar.Blood samples were taken from the patients before the induction of anesthesia and one hour post extubation.The concentration of S100βprotein was determined by ELISA.The Mini Mental State Examination（MMSE）was evaluated for all patients on the day before surgery,at 5-7days postoperative and at 3months postoperative.Results The concentration of S100βprotein was similar between group D and group M before surgery.The concentration of S100βprotein was no statistical significance postoperative,although it was lower in group D than in group M.The increasing of S100βprotein was lower in group D than group M（P〈0.01）.The increasing of S100βwas positive correlative with the incidence of POCD at 5-7days after surgery（r=0.370,P〈0.01）.There was no statistical significant of the incidence of POCD between the two groups at 5-7days and at 3months after surgery.Conclusion Dexmedetomidine pretreatment reversed the increasing of S100βprotein that compared with midazolam,but not statistically difference of the incidence of POCD that evaluated through MMSE test in older patients underwent the selected non-cardiac or non-neurosurgery surgery.