右美托咪啶对老年腹腔镜宫颈癌根治术后认知功能的影响

目的观察右美托咪定（DEX）对老年腹腔镜宫颈癌根治手术患者术后认知功能的影响。方法选择美国麻醉师协会（ASA）I或Ⅱ级择期行腹腔镜宫颈癌根治手术的患者100例，随机双盲分为右美组（D组）和对照组（C组）。D组在常规全麻基础上加用DEX，C组给予相应生理盐水，气腹建立后，所有患者采用400Trendelenberg体位，于手术前1d（D1）和手术后1d（D2）、3d（D3）、7d（D4）进行简易智力状态检查（MMSE）评分及血清白介素-6（IL-6）、血清S10013蛋白含量的检测。结果与D1时间点比较，两纽患者在D2时间点均出现MMSE评分的下降（P〈0．05）及IL-6、S100B蛋白表达水平的增高（P〈0．05）；与C组比较，D组在D2及D3时间点MMSE评分更高（P〈0．05），IL-6、S100B蛋白表达水平更低（P〈0．05）；D组在D4时MMSE评分及IL-6表达水平恢复至术前水平。结论右美托咪定可使老年腹腔镜宫颈癌根治手术患者术后认知功能下降，降低术后IL-6、S100B蛋白的表达水平，其作用机制可能与右美托咪啶能减轻炎症反应相关。

Objective To observe the effect of dexmedetomidine on cognition function in elderly patients after laparoscopic cervical cancer radical surgery. Methods A total of one hundred elderly patients （ American society of Anesthesiologists ASA I -or lI level ） , scheduled for laparoscopic cervical cancer radical, were randomly and double-blind divided into 2 groups： using a random number table： dexmedetomidine group （ group U ） and control group （ group C ） , 25 cases in each group. Dexmedetomidine were applied in group D and group C was given 0.9% sodium chloride injection on the basis of routine general anesthesia, respectively. After pneumoperitoneum was established , all the patients were adopted 40~ Trendelenberg position. Blood samples were obtained for determination of the plasma concentration of interleukin-6, S 10013 protein before the induction of anesthesia within the preoperative ld （ DI ） , within the postoperative ld （ D2 ） , 3d （ D3 ） , 7d （ D3 ） , while the score of Mini- Mental State Examination （ MMSE ） was recorded at the same time. Results Compared with D1, the scores of MMSE were significantly decreased and the levels of IL-6, S 100 13 protein were significantly increased in both two groups at D2 （ P〈0.05 ） . Compared with group C, the scores of MMSE were significantly elevated and the serum concentrations of IL-6, S100 13 protein were significantly reduced at D2 and D3 in group D （ P〈0.05 ） . The scores of MMSE and the serum concentrations of IL-6, S 100 13 protein were recovered to the state of preanesthesia at the time point of D4 in group D. Conclusion Ulinastatin can improve the postoperative cognition in the elderly patients underwent laparoscopic cervical cancer radical, reduce the level oflL-6, S 100 13 protein.The mechanism may involve inhibition of infiammatory reaction.