右美托咪啶联用对老年缺血性脑血管病的作用对照研究

Comparative study of the effect of comined dexmedetomidine on the elderly patients with ischemic cerebrovascular disease

目的探讨联合应用右美托咪啶对老年缺血性脑血管病患者全麻术后认知功能的影响。方法选择2013-06—2016-06行全麻手术的老年缺血性脑血管病患者80例,根据随机数字表法分为异氟烷组(A组)、异氟烷+右美托咪啶组(B组)、七氟烷组(C组)、七氟烷+右美托咪啶组(D组),每组20例。麻醉前B组与D组静脉泵注右美托咪啶,A组与C组则以等量9g/L盐水替代右美托咪啶以相同方法静脉泵注。麻醉维持时A组与B组吸入异氟烷,C组与D组吸入七氟烷。观察术后认知功能,测定MMSE评分;并记录各组术前(T0)、插管后(T1)、手术关腹前(T2)、术后(T3)的HR、SBP、DBP、MAP、PetCO_2、SpO_2的变化。结果各组术后MMSE评分比较,4组术后1d、3d各组MMSE评分均较同组术前1d明显降低,差异均有统计学意义(P均<0.05)。术后1d、3dB组较A组评分高,C组较D组评分高,差异均有统计学意义(P均<0.05)。各组不同时间点生命体征指标比较,4组在插管后HR降低,与术前比较,B、D组HR值在插管后、关腹前、术后均明显下降(P均<0.05);A、C组分别与B、D组比较,HR值在插管后、关腹前、术后均明显升高(P均<0.05)。4组在插管后SBP、DBP均明显降低,直到手术后慢慢上升,术后A、C组明显升高,高于B、D组(P均<0.05)。结论联合应用右美托咪啶,可减少麻醉性镇痛镇静药的用量,降低POCD的发生率,且有保护脑细胞的作用,可改善老年缺血性脑血管病患者术后的早期认知功能。

Objective To explore the effect of dexmedetomidine on cognitive function after general anesthesia in elderly ischemic cerebrovascular disease patients.Methods Eighty elderly ischemic cerebrovascular disease patients from June 2013 to June2016 were included in the study,there were 46 males and 34 females,60~82 years old,50~79 kg.According to the random number table method,they were divided into isoflurane group(group A),isoflurane+ dexmedetomidine group(group B),seven halothane group(group C),seven halothane+ dexmedetomidine group(group D),20 cases in each group.Before anesthesia,group B and group D received intravenous infusion of dexmedetomidine;group A and group c received intravenous infusion of the same amount of 9 g/L saline.When anesthesia was maintained,group A and group B received isoflurane,and group C and group D received seven halothane.The postoperative cognitive function was observed and the MMSE score was measured.The changes of HR,SBP,DBP,MAP,PetCO_2 and Sp0_2 before operation(T0),after intubation(T1),before closing abdomen(T2)and after operation(T3)were recorded in each group.Results Comparison of postoperative MMSE score of each group:the MMSE scores of 1 day and3 days in the 4 groups after operation were lower than those in the same group before operation,and the differences were statistically significant(all P<0.05).The MMSE scores of 1 day and 3 days in group B and C after operation were higher than those in group A and D,and the differences were statistically significant(all P<0.05).Comparison of vital signs at different time points in each group:The HR of the 4 groups decreased after intubation,compared with the preoperative,the HR values of B and D groups decreased significantly after intubation,before closing abdomen and after operation(all P<0.05),the A and C groups were compared with those of B and D groups,the HR values of B and D groups increased significantly after intubation,before closing abdomen and after operation(all P<0.05).The SBP and DBP of the 4 groups were obviously decreased until the operation,after operation,group A and C increased significantly,the value were higher than those in group B and group D(all P<0.05).ConclusionThe combination of dexmedetomidine can reduce the amount of narcotic analgesic sedative,reduce the occurrence of POCD,protect the brain cells and improve the early postoperative cognitive function in the elderly ischemic cerebrovascular disease patients.