不同剂量右美托咪定对老年肺癌术后早期认知功能的影响

Effect of different doses of dexmedetomidine on early postoperative cognitive function in elderly patients treated with lung cancer operation

目的:研究右美托咪定(Dex)对老年肺癌术后早期认知功能的影响及其与麻醉药物剂量的相关性。方法:择期全麻下行肺叶或全肺切除老年患者60例,随机分为对照组(C组)、低剂量Dex组(LD组)、中剂量Dex组(MD组)和高剂量Dex组(HD组)各15例。分别于麻醉诱导前(T0)、进胸时(T1)、术毕(T2)和术后1 d(T3)记录患者平均动脉压、心率(HR)和脉搏血氧饱和度;通过神经功能测验项目简易精神状态评价量表(MMSE)进行术前1 d及术后第1、3、7天对4组患者术后认知功能评分,通过躁动评分表记录麻醉后恢复室(PACU)镇静评分。结果:与T0比较,C组T1平均动脉压明显升高(P<0.01),LD组、MD组和HD组T2、T3HR均降低(P<0.05~P<0.01)。与C组比较,LD组、MD组和HD组T1~T3HR均降低(P<0.05~P<0.01)。4组患者PACU评分差异均无统计学意义(P>0.05)。与术前1 d比较,C组术后第1天MMSE评分显著降低(P<0.01)。与C组比较,其他3组术后第1天MMSE评分均明显升高(P<0.01),4组术后第1天认知功能障碍发生率差异有统计学意义(P<0.05)。结论:Dex在老年患者肺叶或全肺切除术中可以稳定血流动力学,并且能够降低术后认知功能障碍的发生率,且与麻醉药物的剂量无明显的依赖性。

Objective：To study the effects of dexmedetomidine（Dex） on early postoperative cognitive function in elderly patients treated with lung cancer operation, and its correlation with the anesthetic drug dose. Methods： Sixty elderly patients scheduled by lobectomy or pneumonectomy under general anesthesia were randomly divided into the control group （ group C）, low dose Dex group （group LD）,middle dose Dex group （group MD） and high dose Dex group （group HD）（ 15 cases each group）. The mean arterial pressure ,heart rate and blood oxygen saturation in all patients were detected before anesthesia induction（ T0 ） ,opening the chest（ T1 ）, end of operation（T2 ） and 1 d after operation LD（ T3 ）. The postoperative cognitive function in four groups were measured using minimental state examination method（MMSE） 1 d before operation,and 1 d,3 d and 7 d after operation. The sedation scores of all patients were recorded using the Sedation-Agitation Scale in postanesthesia care unit （PACU）. Results：Compared with the T0 time-point, the mean arterial pressure at T1 in group C significantly increased（P 〈0.01 ） ,and the heart rate at T2 and T3 in LD,MD and HD groups decreased（P 〈 0.05 to P 〈 0.01 ）. Compared with the group C, the heart rate at T1 to T3 decreased （P 〈 0.05 to P 〈 0.01 ）. The differences of the PACU scores between four groups were not statistically significant （ P 〉 0.05 ）. Compared 1 d before operation, the MMSE score in group C decreased significantly 1 d after operation （P 〈 0.01 ）. Compared with group C, the MMSE scores in other three groups significantly increased 1 d after operation（ P 〈 0.01 ）. The differences of the incidences of postoperative cognitive dysfunction between four groups were statistically significant 1 d after operation（ P 〈 0.05 ）. Conclusions：The application of Dex in elderly patients treated with lobectomy or pneumonectomy can maintan the hemodynamic stability, and reduce the incidence of postoperative cognitive dysfunction, which has no obvious dependence on the anesthetic drug dose.