不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者术后认知功能的影响

The Effect of Different Doses of Dexmedetomidine Anesthesia on Postoperative Cognitive Function in Elderly Patients Undergoing Total hip Arthroplasty

目的探讨不同剂量右美托咪定(dexmedetomidine,DEX)麻醉维持对老年全髋关节置换术患者术后认知功能的影响。方法选取老年全髋关节置换术87例,按麻醉维持DEX剂量不同分为低剂量组、高剂量组与对照组3组各29例。麻醉维持低剂量组给予盐酸DEX每小时0. 4μg/kg持续静脉泵入,高剂量组给予盐酸DEX每小时0. 8μg/kg持续静脉泵入,对照组给予同等剂量0. 9%氯化钠注射液持续静脉泵入。观察比较3组术前1 d及术后1、3 d认知功能及血清S-100β蛋白、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)水平,以及麻醉10 min后Ramsay镇静评分、术后苏醒时间及拔管时间。结果术后1 d,简明精神状态量表(MMSE)评分3组均低于术前1 d,低剂量组和高剂量组均高于对照组;术后3 d,MMSE评分高剂量组与对照组均低于术前1 d,低剂量组和高剂量组均高于对照组,低剂量组高于高剂量组,差异有统计学意义(P <0. 05)。术后1 d,血清S-100β蛋白、hs-CRP及IL-6水平3组均较术前1 d明显升高,低剂量组、高剂量组均明显低于对照组,低剂量组明显低于高剂量组;术后3 d,血清S-100β蛋白、hs-CRP及IL-6水平高剂量组与对照组均较术前1 d明显升高,低剂量组、高剂量组均明显低于对照组,低剂量组明显低于高剂量组,差异有统计学意义(P <0. 05)。麻醉10 min后Ramsay镇静评分低剂量组明显高于高剂量组与对照组;术后苏醒时间及拔管时间低剂量组和高剂量组均明显短于对照组,低剂量组均明显短于高剂量组,差异有统计学意义(P <0. 05)。结论老年全髋关节置换术患者采用每小时0. 4μg/kg盐酸DEX持续静脉泵入麻醉维持可以提升认知功能,降低血清S-100β蛋白、hs-CRP及IL-6水平,提高麻醉后10 min Ramsay镇静评分,缩短术后苏醒时间及拔管时间。

Objective To investigate the effects of different doses of Dexmedetomidine （DEX） anesthesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty. Methods Eighty-seven patients who underwent total hip arthroplasty were selected and divided into low-dose DEX group （ n =29）, high-dose DEX group （ n =29） and control group （ n =29） according to different doses of DEX. The low-dose and high-dose DEX groups were given continuous intravenous infusion of 0.4 μg / kg and 0.8 μg/kg of DEX per hour respectively. The control group was given continuous intravenous infusion of the same dose of 0.9% sodium chloride injection. The cognitive function and serum S-100β protein, hs-CRP and IL-6 levels 1d before operation and 1 and 3 days after operation were recorded and compared. Moreover, Ramsay sedation score 10 min after anesthesia, recovery time and extubation time were compared between the 3 groups. Results On the 1 st postoperative day, the MMSE scores in the 3 groups were lower than those at 1 d before operation. The scores in low-dose DEX group and the high-dose DEX group were significantly higher than those in the control group. On the 3 rd day after operation, the MMSE scores in the high-dose DEX group and the control group were lower than those at 1 d before operation, and the scores in the low-dose DEX group and the high-dose DEX group were higher than those in the control group. In addition, the scores in the low-dose DEX group were higher than those in the high-dose DEX group, and the difference was statistically significant （ P 〈0.05）. On the 1 st postoperative day, serum S-100βprotein, hs-CRP and IL-6 levels were significantly higher than those 1 d before operation. The scores in the low-dose DEX group and high-dose DEX group were significantly lower than those in the control group, and those in the low-dose DEX group was remarkably lower, as compared with those in the high-dose DEX group; at 3 days after operation, serum S-100β, hs-CRP and IL-6 levels in the high-dose DEX group and the control group were significantly higher than those at 1d before operation, and those scores in the low-dose DEX group and the high-dose DEX group were significantly lower than those in the control group. The scores in the low-dose DEX group was significantly lower than those in the high-dose DEX group, and the difference was statistically significant （ P 〈0.05）. The Ramsay sedation score 10 min after anesthesia was significantly higher in the low-dose DEX group than in the high-dose DEX group and the control group; the postoperative recovery time and extubation time were significantly shorter in the low-dose DEX group and the high-dose DEX group than those in the control group, which was markedly shorter in the low-dose DEX group than in the high-dose DEX group, and the difference was statistically significant （ P 〈0.05）. Conclusion For elderly patients undergoing total hip arthroplasty, continuous intravenous administration of DEX （0.4 μg/kg per hour） can improve cognitive function, reduce S-100β protein, hs-CRP and serum IL-6 protein levels, improve Ramsay sedation score 10 min after anesthesia, and shorten postoperative recovery time and extubation time.