右美托咪啶对阻塞性睡眠呼吸暂停患者术后认知功能的影响

Effects of dexmedetomidine on postoperative cognitive function in patients with obstructive sleep apnea

目的:探讨右美托咪啶对阻塞性睡眠呼吸暂停(OSA)患者术后认知功能的影响。方法:择期拟行膝关节置换术的OSA患者50例,随机分为右美托咪啶组(DEX组,n=25)和对照组(C组,n=25),分别在麻醉前和术中给予右美托咪啶和等量生理盐水持续泵注,两组患者的麻醉诱导和维持方法相同。于围术期不同时间点评估患者认知功能障碍发生情况;分别于麻醉前(T1)、术后3 h(T2)、6 h(T3)、24 h(T4)、48 h(T5)5个时间点测定静脉血中S100β、神经元特异性烯醇化酶(NSE)水平。结果:术后第1天DEX组的MMSE评分高于对照组,差异有统计学意义(P<0.05);DEX组MMSE评分早于对照组恢复至术前水平。T2、T3、T4时刻两组血清S100β蛋白、NSE水平均较T1显著升高,T3时刻达到峰值,但DEX组升高幅度低于对照组,差异有统计学意义(P<0.05)。结论:围术期应用右美托咪啶可以降低OSA患者术后认知功能障碍的发生率,其机制可能与神经保护有关。

Objective To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction （POCD） in patients with obstructive sleep apnea. Methods A total of 50 patients with obstructive sleep apnea were divided into 2 groups： a dexmedetomidine group and a control group. Dexmedetomidine and 0.9% saline solution were given before and during the operation in the dexmedetomidine group and the control group respectively. MMSE scores were estimated at different time, and the concentration of serum S10013 and NSE were detected before anesthesia at 3 h, 6 h, 24 h and 48 h after operation. Results One day after surgery, MMES score decreased significantly in both groups,of which MMES was notably higher in the DEX group than that in the control group （P 〈 0.05）. In both groups, S10013 and NSE levels were significantly higher at T2, T3 and T4 than those at T1, and were the highest at T3 （P〈0.05）. S100β and NSE levels were significantly lower in the DEX group than those in the control group （P〈0.05）. Conclusion Dexmedetomidine can reduce the incidence of POCD in patients with obstructive sleep apnea. Its mechanism may relate to neuroprotection.