右美托咪定对全麻后老年患者早期认知功能的影响

The effect of dexmedetomidine to postoperative cognitive dysfunction on the elder underwent general anesthesia

目的研究右美托咪定对全麻老年患者术后早期认知功能的影响。方法选择择期行腹部手术的老年患者80例,随机分为右美托咪定组（D组）43例和对照组（C组）37例。所有患者均不用术前药。D组使用静脉泵泵注右美托咪定负荷剂量0.4μg/kg（10min泵注完）,然后以0.4μg/kg·h维持静脉泵注,术前30min停药;C组以同样方式输注生理盐水。两组患者均以丙泊酚2mg/kg、芬太尼2μg/kg、顺苯璜酸阿曲库铵0.15mg/kg诱导。插管成功后接麻醉呼吸机,设定呼吸参数：潮气量8~10ml/kg,呼吸频率12~14次/分,维持PETCO235~45mmHg。术中持续吸入1%~2.5%七氟醚,并持续微量泵注瑞芬太尼0.1~0.2μg/kg·min维持麻醉。术中维持血压降低或升高不超过基础值的30%,根据手术操作需要酌情追加顺苯璜酸阿曲库铵。采用简易智力量表（MMSE）对术前及术后第7天进行评分。此外,分别于术前（T0）、术毕（T1）、术后2h（T2）和术后第7d（T3）4个时间点抽取静脉血,进行血清S100β蛋白水平测定。结果 D组与C组的术后认知功能障碍（POCD）发生率差异无统计学意义（P〉0.05）。在发生POCD的患者中,其T1、T2相血清S100β蛋白水平明显高于未发生POCD的患者（P〉0.05）。在T1、T2时点血清中S100β蛋白含量与同组T0相比较均明显增高（均P〈0.01）,T2时达高峰,T3时恢复至T0时水平。结论对老年患者术前使用负荷剂量0.4μg/kg右美托咪定,是一种较为安全的术前用药方式,不会增高POCD的发生风险。

Objective To investigate the effect of dexmedetomidine（DEX）to postoperative cognitive dysfunction（POCD）on the elder underwent general anesthesia.Methods 80 old patients underwent abdominal surgery were divided into DEX group and Control group according to using or non-using DEX.In DEX group,Dexmedetomidine was infused with a loading dose of 0.4μg/kg within 10 min and maintained at 0.4μg/kg·h using micro-pump.A same dose of saline was given in Control group at the same rate.The patients in two groups both were induced with Propofol（2mg/kg）,Fentanyl（2μg/kg）and atracurium（0.15mg/kg）.After anesthesia intubation,a respiratory machine was connected and the respiratory parameter was set as：tided volume of 8~10ml/kg,respiratory rate at 12-14breaths/min,PETCO2 of 35~45mmHg.1% ~2.5%sevoflurane was inhaled during surgery and Fentanyl（0.1~0.2μg/kg·min）was given to maintained anesthesia using micro-pump.The mini-mental state examination（MMSE）was used to evaluate the cognitive function of patients in pre or seven days post surgery.Meanwhile,the serum level of S100β protein was detected at preoperaiton（T0）,post operation（T1）,two hours post operation（T2）,seven days post operation（T3）.Results The occurrence of POCD in DEX group and Control group shown no statistical significance.Among the patients suffered POCD.The serum level of S100β was elevated statistically compared to the patients without POCD.Conclusion The administration of dexmedetomidine operatively on the elderly patients has no the impact on the incidence of POCD.