右美托咪定对高龄患者术后认知障碍影响

Effect of Dexmedetomidine on the Postoperative Cognitive Disorder of Senile Patients

目的探讨右美托咪定对老年患者全麻术后认知功能障碍(POCD)的影响。方法选择该院2013年11月—2016年11月择期全麻下腹部手术的老年患者180例,年龄65~82岁,ASAⅡ或Ⅲ级,随机均分为右美托咪定组(DH组)和生理盐水组(HS组)。DH组在全麻诱导开始,10 min内静脉泵入0.8μg/kg右美托咪定,随后以0.2~0.5μg/(kg·h)维持泵注;HS组静脉泵等量生理盐水。患者接入手术室后常规监测MAP、HR和Sp O2。记录术中丙泊酚、瑞芬太尼用量、自主呼吸恢复时间(停止泵注静脉麻醉药至自主呼吸恢复时间)、拔管时间和睁眼时间。应用简易精神状态量表记录患者术前1 d、术后6 h、1 d、3 d MMSE评分,并记录发生POCD例数。结果 DH组术中丙泊酚用量为(613.33±222.4)mg,瑞芬太尼的用量为(0.88±0.6)mg。HS组的术中的丙泊酚用量为(783.43±252.9)mg,瑞芬太尼的用量为(1.28±0.7)mg。DH组术中丙泊酚和瑞芬太尼用量较HS组明显减少,差异有统计学意义(P<0.05)。DH组的患者的自主呼吸恢复时间为(3.6±1.2)min、拔管时间为(9.8±2.1)min、睁眼时间为(6.5±1.6)min;HS组的患者的自主呼吸恢复时间为(3.0±0.9)min、拔管时间为(10.8±1.1)min、睁眼时间为(5.5±1.7)min。与HS组比较,DH组的自主呼吸恢复时间、拔管时间和睁眼时间明显缩短,差异有统计学意义(P<0.05)。与HS组比较,DH组的术后6 h及术后1 d的MMSE评分明显升高(P<0.01)。而DH组发生POCD 8例,发生率为8.89%,明显低于HS组的发生率21.11%(19例)(P>0.05)。结论右美托咪定对术后认知功能具有一定保护作用,影响老年全麻手术患者的认知功能障碍POCD的发生率。

Objective To discuss the effect of dexmedetomidine on the postoperative cognitive disorder of senile pa-tients. Methods 180 cases of senile patients with sele ct ive abdominal surgery under general anesthesia in our hospital from November 2013 to November 2016 were selected, and the age of them was between 65 to 82, ASA II or III, and they were randomly divided into the DH group and HS group, and the DH group was given the intravenous infusion of 0.8μ g/kg dexmedetomidine within 10 min, and then maintained the infusion at 0.2· 0.5 μ g/（kg·h）, and the HS group was given the intravenous infusion of equivalence normal saline, and the MAP, HR and SpO2 were given the routine monitoring, and the intraoperative propofol, remifentanil dosage and autonomous respiration restoration time, tube draw-ing time and eye opening time were recorded, and the MMSE scores at 1 d before operation and 6 h, 1 d, 3 d after op-eration of the patients were recorded by the simple mini-mental state examination, and the POCD cases were recorded. Results The intraoperative propofol and remifentanil dosages in the DH group were obviously reduced compared with those in the HS group, （613.33±222.4）mg, （0.88±0.6）mg vs （783.43±252.9）mg, （1.28±0.7）mg（P〈0.05）, and the differ-ences were statistically significant, and the autonomous respiration restoration time, tube drawing time and eye open time in the DH group were obviously shortened compared with those in the HS group, （3.6±1.2）min, （9.8±2.1）min,（6.5±1.6）min vs （3.0±0.9）min, （10.8±1.1）min, （5.5±1.7）min, and the differences were statistically significant（P〈0.05）, and the MMSE score at 6h and 1d after operation in the DH group were obviously increased compared with those in theHS group （P〈0.01）, and the incidence rate of POCD in the DH group was obviously lower than that in the HS group, （8 cases vs 19 cases, 8.89% vs 21.11%）,（P〈0.05） . Conclusion Dexmedetomidine has a certain protection effect on the postoperative cognitive function, affecting the incidence rate of cognitive function disorder POCD of senile patients with general anesthesia.