右美托咪定对老年腹腔镜手术患者脑氧饱和度及术后认知功能的影响

Effect of dexmedetomidine on cerebral oxygen saturation and cognitive function in elder patients after laparoscopic surgery

目的：探讨右美托咪定对老年患者行腹腔镜手术脑氧饱和度（Sct O2）的变化及术后认知功能的影响。方法：选择妇科及直肠腹腔镜手术年龄≥60岁患者40例,ASA分级Ⅰ~Ⅱ级,体质量指数18~25 kg/m2,随机分为两组：右美托咪定组（D组,n=20）和对照组（C组,n=20）。麻醉方法为气管插管全身麻醉,D组10 min泵注右美托咪定0.5μg/kg,并按0.3μg/（kg·h）持续泵注;C组给予等量生理盐水。应用FORE-SIGHT近红外光仪监测Sct O_2,收集入室时（T0）、面罩吸氧后（T1）、气腹前（T2）和气腹30 min（T3）的SctO_2、动脉氧分压（PaO_2）、动脉二氧化碳分压（PaCO_2）、平均动脉压（MAP）。术前1 d及术后24 h对患者进行简易智能精神状态检查量表（MMSE）测试评分,计算术后认知功能障碍（POCD）发生率。结果：两组患者SctO_2、PaCO_2及MAP在T3时较T2时增高（P〈0.05）;与术前相比,C组患者术后24 h MMSE降低（P〈0.05）。结论：右美托咪定对老年腹腔镜手术患者SctO_2没有明显影响,但是可以降低POCD的发生率。

Objective： To observe the effect of dexmedetomidine on cerebral oxygen saturation （SctOz） and cognitive function in elder patients after laparoseopic surgery. Methods： Forty patients aged 60 years and older, ASA Ⅰ- Ⅱ patients, undergoing gynecological or rectal laparoscopie surgery were randomly divided into 2 groups （n=20 each）： dexmedetomidine group （group D） and control group （group C）. The anesthesia method was general anesthesia with tracheal intubation. The FORE-SIGHT near infrared instrument was used to monitor SctO2. SetO2, PaO2, PaCO2 and MAP were collected in baseline （TO）, after oxygen by mask （T1）, before pneumoperitoneum （T2） and 30 minutes after pneumoperitoneum （T3）. The cognitive functions of patients in both groups were tested with mini-mental state examination （MMSE）. Test scores at 1 day before surgery, 24 hours after surgery and the incidence of postoperative cognitive dysfunction （POCD） were calculated. Results：SetO2, PaCO2 and MAP of both groups in T3 were significantly higher than those in T2 （P〈0.05）. Compared with preoperative level, the MMSE at 24 hours after surgery in group C was decreased （P〈0.05）. Conclusion： Dexmedetomidine may have no significant effect on SctO2 in elder patients after laparoscopic surgery and can reduce the incidence of early POCD.