右美托咪定对腰椎全麻手术患者术后疼痛及认知功能的影响

Effect of Dexmedetomidine on Postoperative Pain and Postoperative Cognitive Function in Patients with Lumbar Spinal Anesthesia Surgery

目的:探讨右美托咪定对腰椎全麻手术患者术后疼痛及认知功能的影响。方法:选择2014年3月~2015年12月在我院行腰椎全麻手术的84例患者为研究对象,按照随机数字表法分为对照组(42例)和试验组(42例),患者均常规给予芬太尼及顺式阿曲库铵麻醉诱导,试验组患者在麻醉诱导过程中给予右美托咪定静脉注射,对照组患者仅给予氯化钠注射液静脉注射。分别于术前(T0)、手术开始2 h(T2)、术后24 h(T24)检测血清肾上腺糖皮质激素,采用疼痛视觉模拟评分法(VAS)进行疼痛评定;采用简易智能精神状态量表(MMSE)于术后1d和2d进行认知状态评定,并计算术后认知功能障碍(POCD)发生率;同时观察患者不良反应发生情况。结果:试验组患者T2和T24时肾上腺糖皮质激素水平明显低于T0,T2时试验组患者肾上腺糖皮质激素水平明显低于对照组,差异有统计学意义(P<0.05)。试验组患者T2时VAS评分明显低于对照组,差异有统计学意义(P<0.05)。术后1d和2d时试验组患者的MMSE评分高于对照组,POCD发生率明显低于对照组;两组患者术后2d时MMSE评分高于术后1d,POCD发生率明显低于术后1d,差异均有统计学意义(P<0.05)。两组患者均未见除POCD以外的不良反应。结论:右美托咪定有较强的抗氧化能力,可有效减轻腰椎全麻手术患者的疼痛程度,提高患者的认知功能。

Objective： To study the effect of dexmedetomidine on postoperative pain and cognitive function in patients with lumbar spinal anesthesia surgery. Methods： 84 patients with lumbar spine surgery who were treated in our hospital from March 2014 to December 2015 were selected as the research object, they were divided into the control group（42 cases） and the experimental group（42cases） according to random number table methods. All patients were routinely given fentanyl and cisatracurium for anesthesia induction,the patients in the experimental group were given dexmedetomidine by intravenous injection in all process, and the patients in the control group patients were only given sodium chloride injection by intravenous injection. The serum of adrenal cortex hormone were detected in surgery（T0）, 2 h after surgery（T2） and 24 h after surgery（T24）, and the pain assessed by using visual analog pain score（VAS）.The cognitive state were assessed by using simple intelligent mental state scale（MMSE） in postoperative 1 d and 2 d, and the incidence of postoperative cognitive dysfunction（POCD） were calculated.The adverse reactions were observed. Results： The serum of adrenal cortex hormone of the experimental group in T2 and T24 were significantly lower than that in T0, the experimental group in T2 was significantly lower than the control group, the differences were statistically significant; The score of VAS of experimental group in T2 was significantly lower than that in the control group, the difference was statistically significant（P〈0.05）. The MMSE score of experimental group on 1 d and 2 d higher than that in the control group, and the incidence of POCD in experimental group were significantly lower than the control group. The MMSE score of two groups in postoperative 2 d were higher than that in postoperative 1d, the incidence of POCD in postoperative 2 d was significantly lower than that in postoperative 1 d, the differences were statistically significant（P 0.05）. There were no adverse reactions except POCD. Conclusion： The dexmedetomidine have strong antioxidant capacity on treatment patients with lumbar spinal anesthesia surgery, which can effectively ease the pain, improve the cognitive function of patients.