右美托咪啶对老年患者腹部手术后认知功能的影响

Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing abdominal surgery

目的观察右美托咪啶对老年患者腹部手术后认知功能的影响。方法选择ASAⅠ或Ⅱ级行腹部手术老年患者100例,按随机数字表法分为观察组(D组)和对照组(C组),各50例。D组在常规全麻基础上加用右美托咪啶0.5μg/kg,持续量0.2μg/(kg·h),C组给予相应等量的0.9%氯化钠注射液。观察患者注药前(T_0)、麻醉诱导前即刻(T_1)、手术开始即刻(T_2)、手术结束时(T_3)及拔管时(T_4)的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO_2)的变化;于手术前1d(D1)和手术后第1(D_2)、3(D_3)、7(D_4)天进行简易智力状态检查(MMSE)评分及IL-1β水平的检测。结果两组间SpO_2及T_0、T_2、T_3、T_4时HR及MAP均无统计学差异(均P>0.05);D组T_1时HR、MAP明显低于C组(均P<0.05),T_2、T_3时点两组HR、MAP均低于T_0时(均P<0.05);与D_1时点相比,两组患者在D_2时点均出现MMSE评分的下降及IL-1β水平的增高(均P<0.05);与C组相比,D组在D_2、D_3时点MMSE评分更高(P<0.05),IL-1β水平更低(P<0.05);D组在D_3时MMSE评分及IL-1β水平恢复至术前水平。结论右美托咪啶可减轻老年患者腹部手术后的认知功能下降,降低术后IL-1β水平。

】Objective To investigate the effect of dexmedetomidine on postoperative cognitive dysfunction （POCD） inelderly patients undergoing abdominal surgery. Methods One hundred elderly patients with ASAⅠorⅡundergoing abdominalsurgery were randomly divided into study group and control group with 50 in each. In study group patients receiveddexmedetomidine at a loading dose of 0.5μg/kg followed by a continuous infusion of 0.2滋g/kg·h on the basis of routine generalanesthesia; the equal volume of normal saline was given to patients in control group. The heart rate （HR）, mean arterial pressure（MAP） and percutaneous oxygen saturation（SpO2 ） were recorded before injection（T0）, before induction（T1）, at the start of surgery（T2） , at the end of surgery （T3） and at the extubation （T4）.The scores of Mini-Mental State Examination（MMSE） and the serum levelof IL-1β were tested at 1d before surgery, 1d, 3d and 7d after surgery. Results There were no significant differences in MAPand HR at T0, T2, T3, T4 and SpO2 between two group （P〉0.05）, however, MAP and HR in control group were significantly lowerthan those in study group at T1（P〈0.05）, In both groups, HR and MAP at T2 and T3 were significantly lower than those at T0 （P〈0.05）. MMSE score were significantly decreased and IL-1β levels were significantly increased in both groups at D2（both P〈0.05）compare with those at D1, MMSE scores were higher and IL-1β levels were lower at D2 and D3 in study group compared tocontrol group, MMSE scores and IL-1β levels in study group returned to the pre-anesthesia levels at D3. ConclusionDexmedetomidine can alleviate the decline of cognitive function and decrease IL-1β level in elderly patients undergoingabdominal surgery, suggesting that it may be a better choice for the elderly patient in general anesthesia.【