右美托咪定对老年术后机械通气病人睡眠与认知功能影响

EFFECT OF DEXMEDETOMIDINE ON SLEEP AND COGNITIVE FUNCTION IN POST-OPERATIVE ELDERLY PATIENTS WITH MECHANICAL VENTILATION

目的评估右美托咪定对ICU老年术后机械通气病人睡眠及认知功能的影响。方法取行结直肠恶性肿瘤切除术后老年机械通气病人60例,随机分为右美托咪定组(D组)和咪达唑仑组(M组),每组30例。所有病人常规给予芬太尼持续泵入镇痛,D组以0.2~1.5μg/(kg·h)持续泵入右美托咪定,M组以0.02~0.10 mg/(kg·h)持续泵入传统镇静药咪达唑仑,维持Richmond躁动-镇静评分(RASS)-2~0分,并维持BIS值在65~85。记录病人术后转入ICU第一夜22:00至次日6:00睡眠脑电图。分别于术前(T1)及术后第1(T2)、3(T3)、7(T4)、14天(T5)采用简易精神状态评价量表(MMSE)进行评分。结果 D组睡眠效率、N3期睡眠占比和快速动眼期睡眠占比均明显高于M组(t=2.69~3.44,P<0.05),N1期睡眠占比、非快速动眼期睡眠占比和觉醒指数均明显低于M组(t=2.83~3.73,P<0.05),两组N2期睡眠占比比较差异无显著性(P>0.05)。两种镇静药物及5个时间点间MMSE评分比较差异均有显著性(F=7.41、180.79,P<0.05)。M组T2、T3、T4时的MMSE评分较D组显著降低(t=2.63~4.21,P<0.05)。D组病人T4时的MMSE评分已升高至术前水平(P>0.05),而M组病人至T5时才恢复至术前水平(P>0.05)。结论与咪达唑仑比较,右美托咪定镇静诱导睡眠效率高,睡眠结构接近自然睡眠,术后早期病人认知功能降低少,并且认知功能恢复快。右美托咪定为老年择期手术后短期机械通气病人镇静较理想选择。

Objective To evaluate the effect of dexmedetomidine on sleep and cognitive function in elderly patients with short-term mechanical ventilation（MV）in ICU after surgery. Methods Sixty elderly patients with MV after surgery for colorectal cancer were equally randomized to dexmedetomidine group（D group）and midazolam group（M group）.All the patients were given continuous pump analgesia（CPA）with Fentanyl.Patients in the D group were given CPA with dexmedetomidine 0.2-1.5μg/（kg·h）,and patients in the M group were given CPA with midazolam 0.02-0.10mg/（kg·h）.The Richmond agitation sedation score（RASS）was maintained at-2-0mark,and BIS at 65-85.Sleep electroencephalograph（EEG）was recordedfrom the first night patient was transferred to ICU after surgery to next morning（22：00to the next day 6.00）.Applying MiniMental Status Examination（MMSE）,the mental state before surgery（T1）,and day 1（T2）,day 3（T3）,day 7（T4）and day 14（T5）was scored,respectively. Results Compared with M group,the sleep efficiency,N3%TST,and REM%TST in D group were significantly higher（t=2.69-3.44,P〈0.05）and N1%TST,NREM%TST and arousal index were significantly lower（t=2.83-3.73,P〈0.05）,and no significant differences were found in N2%TST between the two groups（P〈0.05）.The differences between the two sedative drugs and MMSE score among five time points were significant（F=7.41,180.79;P〈0.05）.Compared with D group,the MMSE score of T2,T3 and T4in M group declined（t=2.63-4.21,P〈0.05）.In D group,MMSE score at T4 was increased to preoperative level,while in M group,the MMSE score was restored to preoperative level until T5. Conclusion Compared with Midazolam,Dexmedetomidine has the following advantages：higher efficiency of sedation induced sleep and sleep structure close to natural sleep,less early postoperative cognitive impairment,and fast recovery of cognitive function.Dexmedetomidine is an ideal sedative for elderly patients with short-term mechanical ventilation after selective operation.