不同剂量右美托咪啶对60岁以上髋部手术患者的脑保护效应

Cerebral protective efficacy of different doses of dexmedetomidine for ederly patients over 60 years with hip operation

目的:探讨不同剂量右美托咪啶(Dex)对60岁以上髋关节置换手术患者的脑保护效应。方法:将80例60岁以上择期在椎管内麻醉下行髋关节置换手术患者随机分为4组:D0组为不用Dex对照组,D1、D2和D3组分别于椎管内麻醉后按0.5、0.75和1.0μg/(kg·h)静脉输注Dex,并于术前、术中及术毕时抽血检测TNF-α、IL-10、NSE、S100b,以及进行蒙特利尔认知功能评估。结果:4组患者的IL-10水平在术中及术毕时逐渐升高,其中D3组的增高比其他3组显著,4组组间比较具有统计学差异(P<0.05)。各组患者的血浆NSE和S100β水平在术中及术后时均较术前逐渐升高,其中D0组的增高较D2和D3组更为显著(P<0.05)。D3组于术后第1、7天的Mo CA评分最高,4组组间比较差异具有统计学意义(P<0.05)。结论:60岁以上患者椎管内麻醉髋关节置换手术中静脉输注Dex具有一定的脑保护作用,其中以1.0μg/(kg·h)静脉输注的作用更为明显。

Objective To investigate the Cerebral protective effects of different dosage of Dex for patients over 60 yeas old undergoing selected hip replacement surgery. Methods 80 elderly patients over 60 years old with selected hip replacement surgery in spinal anesthesia were randomly divided into 4 groups： blank control DO group（no Dex used）; D1, D2 and D3 groups, in each group Dex was intravenous infused at the rate of 0.5, 0.75 and 1.0 μg/（kg-h）, respectively after spinal anesthesia.Venous blood was extracted preoperatively, intraoperatively （after skin incision 1 h） and postoperatively respectively to detect TNF-α, IL-10, NSE and S10013 and Montreal cognitive function assessment was conducted at the same time. Results The intraoperative and postoperative levels of IL-10 of the four groups increased gradually, especially in the D3 group, and the difference among the four groups was significant （P 〈 0.05）. Intraoperative and postoperative plasma concentration levels of NSE and S10013 in each groups increased gradually more than that of preoperation, especially the DO group in which the increasement was more significant than D2 and D3 group （P 〈 0.05）. The MoCA score of the D3 group in the postoperative 1 d and 7 d was the highest, and the difference among the four groups was significant（P 〈 0.05）. Conelusion Intraoperative intravenous infusion of Dex has a certain brain protective effect on ederly patients over 60 years old with hip replacement surgery in spinal anesthesia, while effect of the rate of 1.0 μg/（kg. h） is the most obvious.