右美托咪啶对老年患者在髋关节手术麻醉苏醒期术后认知功能、氧代谢的影响

Effect of dexmedetomidine on cognitive function,oxygen metabolism of anesthesia and operation in elderly patients in elderly patients after operation of hip joint

目的分析右美托咪啶对老年患者在髋关节手术麻醉苏醒期及术后认知功能、氧代谢的影响,探讨其对术后认知功能障碍（Postoperative cognitive dysfunction,POCD）的防治作用。方法选取我院2012年5月-2014年5月收治的86例拟行腰硬联合麻醉髋关节手术的老年患者,按照随机数字表分为观察组及对照组,各43例。分别于麻醉前给予盐酸右美托咪定及等量生理盐水静脉微泵泵注,并给予相同的麻醉诱导及维持药物。比较两组患者麻醉苏醒期、术后认知功能及氧代谢变化。结果两组患者手术时间、出血量、输血输液量比较,差异无统计学意义（P〉0.05）。两组患者T2-T3时段MAP均显著上升,对照组上升更为明显,差异有统计学意义（P〈0.05）;观察组围术期HR未见明显变化,对照组T2-T3时段HR显著上升,差异有统计学意义（P〈0.05）;对照组围术期Ramesay评分未见明显变化（P〉0.05）,观察组T2时点后Ramesay评分呈进行性上升。两组患者术后3 d MMSE得分均较术前1 d显著降低,对照组降低更为明显,差异有统计学意义（P〈0.05）。两组患者T2、T3时点S100β蛋白水平均显著上升,对照组上升更为明显,差异有统计学意义（P〈0.05）。观察组POCD发生率为7.0%（3/43）,对照组为18.6%（8/43）,观察组POCD发生率显著低于对照组,差异有统计学意义（χ^2=6.184,P〈0.05）。两组患者自T2时点起脑氧代谢指标均出现明显变化,对照组变化更为剧烈,差异有统计学意义（P〈0.05）。结论右美托咪定能够保持老年患者髋关节手术围术期生命体征平稳,保护脑氧代谢,有利于POCD的防治。

Objective： To analyze the effect of dexmedetomidine on cognitive function,oxygen metabolism of anesthesia and operation in elderly patients in elderly patients after operation of hip joint,on postoperative cognitive dysfunction（ Postoperative cognitive,dysfunction,POCD） the effects of prevention and treatment. Methods： Elderly patients in our hospital from 2012 May - 2014 year in May 86 cases undergoing combined spinal epidural anesthesia for hip joint operation,were randomly divided into observation group and control group,43 cases in each. Respectively before anesthesia given dexmedetomidine hydrochloride and normal saline intravenous micro pump infusion,and give the same anesthesia induction and maintenance agents. Results： Two groups of patients with operation time,bleeding volume,blood transfusion volume,there was no statistically significant difference（ P〈0. 05）. Two groups of patients with T2- T3 stage MAP increased significantly,the control group increased more significantly,the difference was statistically significant（ P〈0. 05）; the observation group had no obvious change of perioperative HR,control group T2- T3 period HR increased significantly,the difference was statistically significant（ P〈0. 05）; Control group peri operative ramesay score showed no significant change（ P〉0. 05）,the observation group T2 ramesay score was increased. Two groups of patients with 3 D MMSE scores were compared with preoperative 1 D decreased significantly,the control group decreased more significantly,the difference was statistically significant（ P〉0. 05）. Two groups of patients with T2,T3 at S100 β protein level increased significantly,the control group increased more significantly,the difference was statistically significant（ P〈0. 05）. The observation group the incidence of POCD was 7%（ 3 /43）,the control group was 18. 6%（ 8 /43）,the observation group the incidence of POCD was significantly lower than the control group,the difference was statistically significant（ P〈0. 05）. Two groups of patients from the T2 point on cerebral oxygen metabolism were significantly changed,the control group were more severe,the difference was statistically significant（ P〈0. 05）. Conclusions： Dexmedetomidine can keep that the elderly patients undergoing hip operation perioperative stable vital signs,protect the cerebral oxygen metabolism,is beneficial to the prevention and treatment of POCD.