不同剂量右美托咪啶镇痛泵应用对剖宫产术后认知功能影响的研究

Effects of Different Doses of Dexmetidine Analgesia Pump on Cognitive Function after Cesarean Section

目的:拟探讨剖宫产术后镇痛泵应用不同剂量右旋美托咪啶对认知功能影响。方法:对所有行剖宫产的产妇术后均采用镇痛泵镇痛,根据右旋美托咪啶使用随机分为3组各组60例,采用布比卡因和吗啡镇痛泵镇痛的产妇为对照组,0.3ug/kg和0.6ug/kg右旋美托咪啶分别为小剂量和大剂量右旋美托咪啶组。观察产妇术后镇痛效果及检测产妇血清皮质醇、血管紧张素II(AngII)、肾上腺素(E)和去甲肾上腺素(NE)水平和产妇认知功能指标包括MMSE评分以及认知功能相关的血清标记物(S-100β、TNF-a和IL-6)表达水平以及POCD的发生率。结果:小剂量右美托嘧啶组镇痛效果明显优于对照组和大剂量右旋美托嘧啶组(P<0.05);且小剂量右美托嘧啶组血清皮质醇、AngII、E和NE水平和认知功能相关的血清标记物(S-100β、TNF-a和IL-6)表达水平均明显低于对照组和大剂量组(P<0.05);小剂量组MMSE评分高于其他组,而术后第1dPOCD发生率最低(P<0.05)。结论:小剂量右美托咪啶硬膜外腔镇痛泵镇痛可应用于剖宫产术后,能有效降低产妇认知功能障碍的发生。

Objective：To study the effect of different doses of dexmetidine analgesia pump on cognitive function after cesarean section.Methods：All parturients undergoing cesarean section were treated with analgesic pump analgesia.According to the dosage of dexmetidine,all patients were randomly divided into three groups,with 60 cases in each group.Puerpera with bupivacaine and morphine analgesia pump were set as control group,and 0.3 ugr/g and 0.6 ugr/kg dexmetomidine were small dose and high dose dexmetomidine group,respectively.Analgesic effect was observed,and stress response indexes included serum cortisol,Angiotensin II（Ang II）,epinephrine（E）,noradrenaline（NE）,cognitive function indexes such as MMSE grade and serum marker associated with cognitive function included S-100β,TNF-a,IL-6 expression,as well as occurrence rate of POCD were detected.Results：Analgesic effect of small dose group was obviously better than that of large dose group and control group（P〈0.05）.The expression of serum cortisol,Angiotensin II（Ang II）,epinephrine（E）,noradrenaline（NE）,as well as S-100β,TNF-a,IL-6 in small dose group were significantly lower than those of large dose group and control and group（P〈0.05）.In addition,MMSE grade of small dose group was significantly higher than that of large dose group and control group（P〈0.05）,while the occurrence rate of POCD at postoperative day 1 was lowest（P〈0.05）.Conclusion：Dexmedetomidine with small doses can be used in analgesia after cesarean section by PCA pump,which can effectively reduce the occurrence of cognition impairment.