术中持续性泵注右美托咪定对老年患者腹腔镜术后认知功能的影响

Effect of continuous intraoperative pumping of Dexmedetomidine on cognitive function in elderly patients undergoing laparoscopic surgery

目的探讨术中持续性泵注右美托咪定对老年患者腹腔镜术后认知功能障碍(POCD)的影响。方法选择我院2015年1月-2016年6月择期全麻下行腹腔镜近端胃癌根治术患者44例,随机均分为右美托咪定组(Dex组)和生理盐水组(Ns组)。Dex组全麻诱导前以0.8μg/(kg·h)持续泵注15 min给予负荷剂量,术中以0.4μg/(kg·h)维持镇静,术毕前40 min停药。Ns组给予等容积的生理盐水静脉泵注。分别记录两组患者气管插管前(T_0)、气管插管时(T_1)、手术开始时(T_2)、手术开始30 min(T_3)、拔管前10 min(T_4)、拔管后30 min(T_5)的MAP、HR、SpO_2值。记录术中麻醉药物使用量、手术时间、自主呼吸恢复时间、拔管时间、清醒时间。并于术前1 d(D_0)、术后1 d(D_1)、术后3 d(D_2)记录各观察点的恶心、呕吐与眩晕等不良反应例数。结果在T_1、T_2、T_4、T_5时刻,与Ns组比较,Dex组的MAP、HR值(除T_1外)显著降低(P<0.05);D_1-D_2时刻,与Ns组比较,Dex组的POCD发生率显著降低(P<0.05),恶心呕吐、眩晕发生率差异无统计学意义(P>0.05)。结论术中持续泵注右美托咪定有利于术中循环稳定,减少术中麻醉药物使用量、降低术后POCD发生率,且不增加苏醒时间与不良反应。

Objective To investigate the effect ofintraoperative continuous infusion of Dexmedetomidine on cognitive dysfunction in elderly patients after laparosc opic surgery.Methods 44 patients with laparosc6pic radical gastrectomy underwent elective general anesthesia from January 2015 to June 2016 were randomly divided into Dexmedetomidine group and normal saline group.The loading dose of Dexmedetomidine was maintained at 0.8 μg / （kg.h） for 15 min before anesthesia induction,followed by 0.4 μg / （kg·h） of sedation during surgery and 40 min before the end of surgery in the Dex group.Ns group was given intravenous infusion of equal volume of saline.MAP,HR and SpO2 value were recorded before tracheal intubation （T0）,intubation （T1）,at the beginning of surgery （T2）,at 30 min （T3）,10min before extubation （T4）,30 min after extubation （T5）.The operation time,spontaneous breathing recovery time,extubation time and sober time were recorded.At 1 days （D0）,after 1 day operation （D1）,and postoperative day three （D2）,the number of adverse reactions such as nausea,vomiting and dizziness were recorded.Results At the T1,T2,T4 and T5 time points,MAP and HR （exception of T0 of Dex group were significantly lower than those of Ns group （P〈0.05）.At the time of D1-D2,compared with Ns group, the incidence of POCD in Dex group was significantly lower than that in Ns group （P〈0.05）.There was no significant difference in the incidence rate of nausea and vomiting,vertigo between the two groups （P〉0.05）.Conelusion Intraoperative pumping of Dexmedetomidine during operation is conducive to intraoperative circulatory stability,reduce the use of anesthetic drugs,reduce the incidence of postoperative POCD,and does not increase the awakening time and adverse reactions in the intraoperative continuous injection of Dexmedetomidine.