摘要
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.
作者
肖晖
鲁信星
XIAO Hui;LU Xin-xing(Department of Anesthesiology,Ankang Central Hospital,Ankang,Shaanxi 725000,China)
出处
《临床误诊误治》
2018年第11期55-60,共6页
Clinical Misdiagnosis & Mistherapy
基金
陕西省卫生科研项目(No.D80)