右美托咪定对老年患者腹腔镜宫颈癌根治术后谵妄的预防效果

Efficacy of dexmedetomidine in preventing postoperative delirium in elderly patients undergoing laparoscopic radical resection for cervical cancer

目的评价右美托咪定对腹腔镜宫颈癌根治术老年患者术后谵妄的预防效果。方法择期腹腔镜宫颈癌根治术老年患者80例，年龄65-75岁，体重45-80 kg, ASA分级Ⅱ或Ⅲ级，采用随机数字表法分为2组（n＝40）：右美托咪定组（D组）和常规组（R组）。D组于麻醉诱导后即刻静脉输注右美托咪定0.5 μg·kg^-1·h^-1至术毕，R组给予等容量生理盐水。术后3 d内采用谵妄分级量表法评估谵妄的发生情况；于麻醉诱导前（T0）、术毕（T1）、术后1 h（T2）、6 h（T3）和24 h （T4）时采集颈内静脉球部血样，采用ELISA法测定血清S100β蛋白、神经元特异性烯醇化酶（NSE）、TNF-α及IL-1β的浓度。结果与R组比较，D组术后谵妄发生率降低（38% vs.2%），T1-4时血清S100β蛋白、NSE及TNF-α浓度降低，T2-4时血清IL-1β浓度降低（P〈0.05）。结论麻醉诱导后至术毕静脉输注右美托咪定0.5 μg·kg^－1·h^－1，可显著预防腹腔镜宫颈癌根治术老年患者术后谵妄的发生，其机制与抑制中枢炎症反应，减轻脑损伤有关。

Objective To investigate the efficacy of dexmedetomidine in preventing postoperative delirium in elderly patients undergoing laparoscopic radical resection for cervical cancer.Methods Eighty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients, aged 65-75 yr, weighing 45-80 kg, scheduled for elective laparoscopic radical resection for cervical cancer, were divided into 2 groups （n=40 each） using a random number table： dexmedetomidine group （group D） and routine group （group R）. Dexmedetomidine was infused at a rate of 0.5 μg·kg-1·h-1 after anesthesia induction until the end of operation in group D, while the equal volume of normal saline was given instead in group R. Delirium rating scale was used to assess the development of delirium within 3 days after operation.Blood samples were collected from the jugular bulb before anesthesia induction （T0）, at the end of operation （T1） and at 1, 6 and 24 h after operation （T2-4） to determine the serum concentrations of S100β protein, neuron-specific enolase, tumor necrosis factor-alpha and interleukin-1beta （IL-1β） by enzyme-linked immunosorbent assay.Results Compared with group R, the incidence of postoperative delirium was significantly decreased （38%/2%）, the serum concentrations of S100β protein, neuron-specific enolase, tumor necrosis factor-alpha and IL-1β were decreased at T1-4, and the serum concentrations of IL-1β protein were decreased at T2-4 in group D （P〈0.05）.Conclusion Infusing dexmedetomidine at 0.5 μg·kg-1·h-1 from the end of anesthesia induction until the end of operation can effectively prevent the development of delirium following laparoscopic radical resection for cervical cancer, and the mechanism is related to inhibiting inflammatory responses and reducing brain injury in elderly patients.