不同剂量右美托咪定对腹腔镜胃肠手术全麻老年患者术后早期认知功能的影响研究

Effects of different doses of dexmedetomidine on early postoperative cognitive function in elderly patients undergoing laparoscopic gastrointestinal surgery

目的探析在腹腔镜胃肠手术全麻老年患者中应用不同剂量右美托咪定对术后早期认知功能产生的影响。方法择取2015年1月~2017年12月本院收治的择期腹腔镜胃肠手术全麻老年患者165例,随机将所选患者分成3组,每组55例。A组采用麻醉诱导前给予右美托咪定0.2μg/kg,给药15 min,之后以0.2μg/(kg·h)持续泵注至手术结束前40 min,B组采用麻醉诱导前给予右美托咪定0.5μg/kg,给药15 min,之后以0.5μg/(kg·h)持续泵注至手术结束前40 min,C组给予等容量生理盐水,对3组术后早期认知功能采用简易智力状态检查量表(MMSE)进行分析和比较。结果 MAP、HR方面:3组T_1时刻无明显差异,B组T_2、T_3、T_4、T_5、T_6时点优于A组与C组,差异有统计学意义(P<0.05),A组T_3、T_4、T_5、T_6时点优于C组,差异有统计学意义(P<0.05);MMSE评分方面:术前1天3组无明显差异,术后1天、术后3天、术后7天,与C组相比,A组和B组的分值均较好,差异有统计学意义(P<0.05),且A组与B组相比差异有统计学意义(P<0.05);术后POCD发生率方面:与C组相比,A组和B组均有所下降,但A组无统计学意义,B组差异有统计学意义(P<0.05),A组与B组相比差异有统计学意义(P<0.05)。结论在腹腔镜胃肠手术全麻老年患者中应用右美托咪定可以促进术后早期认知功能恢复,且剂量为负荷剂量0.5μg/kg静脉输注后以0.5μg/(kg·h)持续泵注的效果更佳。

Objective To explore the effect of different doses of dexmedetomidine on early postoperative cognitive function in elderly patients undergoing laparoscopic gastrointestinal surgery. Methods 165 elderly patients were selected from January 2015 to December 2017 in our hospital.The selected patients were randomly divided into 3 groups. Group A was given right metomomidine 0.2 μg/kg before induction of anesthesia, Administration for 15 minutes, and then 0.2 μg/（kg · h） continuous pump to 40 minutes before the end of hand operation. Group B was induced by anesthesia induction. Right metodetomidine was given 0.5 μg/kg and administered for 15 minutes, then 0.5 μg/（kg · h） was pumped continuously to 40 minutes before the end of the operation. Group C was given equal volume of saline. The early cognitive function of the 3 groups was analyzed and compared with a simple mental state examination scale（MMSE）. Results MAP and HR： there was no significant difference between the 3 groups at the time of T1. The time points of T2, T3, T4, T5 and T6 in the B group were better than those in the A group and C group. After 3 days and 7 days after operation, the scores of group A and group B were better than those in group B（P〈0.05）, and there was significant statistical difference between group A and B group（P〈0.05）, and the incidence of POCD in the post operation was lower than that in the C group, but there was no significant difference between the A group and the B group. There was a significant difference between group A and group B（P〈0.05）. Conclusion The application of dexmedetomidine in the elderly patients with laparoscopic gastroenteric surgery can promote the recovery of early postoperative cognitive function, and the dose of 0.5 μg/kg intravenous infusion at a dose of 0.5 μg//（kg·h） after infusion is better.