小剂量右美托咪定与亚麻醉量氯胺酮对长期饮酒老年患者腹腔镜全身麻醉术后认知功能的影响

Effects of low-dose dexmedetomidine and sub-anesthesia ketamine on cognitive function after laparoscopic general anesthesia in elderly patients with chronic alcohol consumption

目的 比较小剂量右美托咪定与亚麻醉量氯胺酮对预防长期饮酒老年患者腹腔镜全身麻醉术后认知功能障碍的效果。 方法 选择年龄〉60岁，ASAⅠ～Ⅱ级，拟在全身麻醉下行腹腔镜胆囊切除术的长期饮酒患者60例，随机分为三组：D组（右美托咪定组），K组（氯胺酮组），C组（等量氯化钠注射液）。术中根据血流动力学指标相应调整丙泊酚和瑞芬太尼的输注剂量。三组患者术中脑电双频谱指数（BIS）值维持在40～50。D组给予右美托咪定0.5 μg/（kg·min），K组给予氯胺酮2.0 μg/（kg·min），C组给予等量氯化钠注射液，剂量术中保持不变。记录各组停药后拔出喉罩时间和苏醒时间。分别于术前1 d及术后1、3、5 d采用简易精神状态量表（MMSE）对患者进行神经精神功能评定。 结果 C组麻醉结束后的苏醒时间和拔出喉罩时间均显著少于D、K组（P〈0.05）。三组患者MMSE评分：与术前1 d比较，C、K组术后1、3 d的MMSE评分明显下降，差异有统计学意义（P〈0.05）；与D组比较，C、K组术后1、3 d的MMSE评分明显下降，差异有统计学意义（P〈0.05）。术后1、3 d，D组术后认知功能障碍（POCD）发生率低于C组，差异有统计学意义（P〈0.05）。 结论 小剂量右美托咪定对术后认知功能具有保护作用，能降低长期饮酒老年患者全身麻醉术后POCD的发生率。

Objective To compare the effects of low-dose dexmedetomidine and subanesthesia ketamine on prevention of cognitive dysfunction after laparoscopic general .anesthesia in elderly patients with chronic alcohol consumption. Methods Sixty patients over 60 years old and ASA Ⅰ - Ⅱ, under- went elective laparoscopic eholecystectomy under general anesthesia were enrolled, they were randomly divided into three groups： group D （dexmedetomidine group）, group K （ketamine group） and group C （saline）. Adjustment of propofol and remifentanil dosage based on hemodynamie parameters. Intraopera- tive bispeetral index （BIS） of three groups sustained in 40-50. Group D- dexmedetomidine 0. 5 μg/（ kg · min）, group K ： ketamine 2.0 μg/（ kg - min）, group C ： equivalent saline and dosages were constant during operation. The times of pulling laryngeal mask air-way out and revival after drug dis- continuance were recorded for every group. The neuropsychological function was evaluated by MMSE at one day before operation, one day after operation, three days after operation and five days after opera- tion. Postoperative score less 2 points than preoperative score that was identified as postoperative cogni- tive dysfunction（POCD）. Results The recovery time and extubation time after anesthesia in group C were significantly less than those in group D and group K（P 〈0.05 ）. MMSE scores of the .three groups： compared with one day before operation, MMSE scores of group C and K decreased Significantly at 1 d and 3 d after operation MMSE scores of group pared with 1 d and 3 d , the difference was statistically significant（ P 〈 0. 05 ） ; Compared with group D, C and group K were significantly lower than those of group D （P 〈 0. 05 ）. Corn- after operation, the inciflence of POCD in group D was lower than that in group C, the difference was statistically significant （P 〈 0. 05）. Conclusions Low-dose dexmedetomidine has a protective effect on postoperative cognitive dysfunction and can reduce the incidence of postoperative cognitive dusfunction after laparoscopic general anesthesia in elderly patients with chronic alcohol con- sumption.