右美托咪定对老年患者全身麻醉术后认知功能障碍的影响

Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia

目的探讨右美托咪定对老年患者全身麻醉术后认知功能障碍的影响。方法选取2016年8月至2017年8月于四川省自贡市第一人民医院拟进行全身麻醉手术的90例老年患者,依据随机数字表法分为对照组和观察组,各45例。观察组患者于全身麻醉开始时静脉泵入0.8μg/kg右美托咪定,随后以0.2～0.5μg/(kg·h)维持泵注;对照组患者于全身麻醉诱导开始时静脉泵注等量的0.9%氯化钠注射液。记录2组患者术前及术后6 h、1 d、3 d的简易精神状态评价量表(MMSE)评分,手术前后的平均动脉压(MAP)、心率、血氧饱和度水平,术中全身麻醉药物用量、术后自主呼吸恢复时间、拔管时间及定向力恢复时间,以及患者切皮时、手术结束时及术后1 h血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平。结果观察组术后6 h、1 d MMSE评分明显高于对照组[(28±5)分比(21±5)分、(27±6)分比(24±5)分];观察组术后MAP和心率明显低于对照组[(81±6)mmHg(1 mmHg=0.133 kPa)比(95±7)mmHg、(70.4±3.5)次/min比(86.4±2.6)次/min];观察组丙泊酚、瑞芬太尼用量明显少于对照组[(506±108)mg比(728±185)mg、(1.8±0.6)mg比(2.6±0.8)mg],自主呼吸恢复时间、拔管时间、定向力恢复时间明显短于对照组[(10±3)min比(13±4)min、(14.3±2.5)min比(17.6±3.2)min、(20±3)min比(22±4)min];观察组切皮时、手术结束时、术后1 h的IL-6、TNF-α水平明显低于对照组,差异均有统计学意义(均P<0.05)。结论右美托咪定可维持老年患者全身麻醉术后的血流动力学稳定,减轻认知功能障碍,降低炎性因子水平。

Objective To investigate the effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia. Methods Ninety elderly patients undergoing general anesthesia surgery from August 2016 to August 2017 in Zigong First People′s Hospital were randomly divided into control group and observation group, with 45 cases in each group. The observation group was intravenously administered 0.8 μg/kg dexmedetomidine at the beginning of anesthesia and consistently administered dexmedetomidine 0.2-0.5 μg/（kg·h） during operation; the control group was intravenously administered the same dose of 0.9% sodium chloride solution at the beginning of anesthesia. The Mini-Mental State Examination（MMSE） score was recorded before and 6 h, 1 d, 3 d after operation. Mean arterial pressure（MAP）, heart rate（HR） and blood oxygen saturation were recorded before and after operation. Intraoperative anesthetic dose, postoperative spontaneous respiratory recovery time, extubation time, orientation recovery time, serum levels of interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） at incision, at the end of operation and 1 h after operation were analyzed. Results The MMSE scores 6 h, 1 d after operation in observation group were significantly higher than those in control group［（28±5） vs（21±5）, （27±6） vs（24±5）］; MAP and HR after operation in observation group were significantly lower than those in control group［（81±6）mmHg vs（95±7）mmHg, （70.4±3.5）times/min vs（86.4±2.6）times/min］; dosages of propofol and remifentanil in observation group were significantly lower than those in control group［（506±108）mg vs（728±185）mg, （1.8±0.6）mg vs（2.6±0.8）mg］; spontaneous respiratory recovery time, extubation time and orientation recovery time in observation group were significantly shorter than those in control group［（10±3）min vs（13±4）min, （14.3±2.5）min vs（17.6±3.2）min, （20±3）min vs（22±4）min］; levels of IL-6 and TNF-α at incision, at the end of operation and 1 h after operation in observation group were significantly lower than those in control group（all P＜0.05）. Conclusion Dexmedetomidine can maintain stable hemodynamics, improve postoperative cognitive function and reduce inflammation in elderly patients undergoing general anesthesia surgery.