右美托咪定复合七氟醚对老年病人开腹手术术后认知功能的影响

EFFECT OF DEXMEDETOMIDINE COMBINDED WITH SEVOFLURANE ON COGNITIVE FUNCTION AFTER LAPAROTOMY IN ELDERLY PATIENTS

目的:探讨右美托咪定(Dexmedetomidine,Dex)复合七氟醚麻醉对老年病人术后认知功能的影响。方法:择期行开腹胃癌根治术病人60例和选择健康人群30例作为对照组(C组)。年龄65～75岁,ASA分级I或II级。采用随机数字表法,将行开腹胃癌根治术病人分为2组(n=30):七氟醚组(S组):七氟醚复合Dex组(D组)。麻醉维持:术中D组以七氟醚复合Dex维持(Dex于气管插管后采用注射泵以0.4μg/(kg.h)持续静脉输注,手术结束30 min前停止输注),S组以七氟醚并持续输入等容积的盐水维持麻醉,监测入室后静卧5 min(T0),切皮后即刻(T1),手术结束前30 min(T2),拔管时(T3)的平均动脉压、心率值,并于T 0、手术结束时(T4)及术后24 h(T5)分别抽取静脉血检测白介素-6(IL-6)。于术前1 d、术后1 d、3 d、7 d时,采用MMSE量表进行认知功能评分,采用Z计分法评判认知功能障碍。结果:D组各个时间点MAP、HR与T 0比较,差异无统计学意义(P>0.05); S组与T 0相比T 3时MAP、HR升高,差异有统计学意义(P<0.05)。S组、D组病人自主呼吸恢复时间、睁眼时间、拔管时间、拔管后5 min清醒状况(OAA/S)评分比较,均无统计学意义(P>0.05)。D组术后第1 d、3 d的MMSE评分均显著高于S组,差异有统计学意义(P<0.05)。S组术后第1 d、3 d出现认知功能障碍的病人分别为5例(19.2%)和2例(7.6%)。D组术后第1 d出现认知功能障碍的病人为2例(7.1%)。D组病人POCD的发生率均显著低于S组,差异有统计学意义(P<0.05)。与T 0时点相比,S组和D组在T 4、T 5时炎症因子(IL-6)浓度增加(P<0.05)。与S组相比,D组在T 4、T 5时IL-6浓度显著降低(P<0.05)。结论:七氟醚复合Dex可以减少老年病人术后血浆IL-6水平,减少术后早期认知功能障碍的发生,并且维持血流动力学平稳,不延长拔管和苏醒时间。

Objective： To investigate the effect of Dexmedetomidine （Dex） combined sevoflurane on the postoperative cognitive function of the elderly. Methods： 60 patients with radical gastrectomy and 30 healthy people were selected as the control group （group C）. The age of 65-75 years, ASA grade I or II grade. The patients were divided into 2 groups （ n =30）： sevoflurane group （group S）： sevoflurane group Dex （group D）. The maintenance of anesthesia in D group with sevoflurane to maintain Dex （Dex after intubation using injection pump with 0.4 ug/ （kg.h） continuous infusion, the end of surgery before 30 min infusion is stopped, S group with sevoflurane） and continued input volume of saline to maintain anesthesia, monitoring after entering 5 min （T0）, immediate repose after skin incision （T1）, 30 min （T2） before the end of surgery, extubation （T3） mean arterial pressure, heart rate, and at the end of surgery, T0 （T4） 24 hours after operation （T5） and venous blood from the detection of interleukin -6 （IL-6）. At 1D, 1D, 3D and 7 d after operation, the cognitive function was scored by the MMSE scale, and the cognitive impairment was evaluated by the Z score. Results： There was no significant difference in MAP and HR between D group and T0 at any time point （T0）. There was no statistically significant difference in spontaneous breathing recovery time, eye opening time, extubation time, and 5 points sober （OAA/S） score after extubation between group S and group D （ P 〉 0.05 ）. The score of MMSE in group D first, third days after operation was significantly higher than that in group S, and the difference was statistically significant （ P 〈 0.05 ）. In group S, 5（ 19.2 %） and 2（ 7.6 %） had cognitive impairment at first, third days after operation. In group D,2 patients （ 7.1 %） had cognitive impairment at first days after operation. The incidence of POCD in group D was significantly lower than that in group S, and the difference was statistically significant （ P 〈 0.05 ）. Compared with T0 time points, the concentration of inflammatory factors （IL-6） in group S and group D increased at T4 and T5 （ P 〈 0.05 ）. Compared with the S group, the concentration of IL-6 in the D group decreased significantly at T4 and T5 （ P 〈 0.05 ）. Conclusion： Sevoflurane combined with Dex can reduce plasma IL-6 level, reduce postoperative cognitive dysfunction and maintain stable hemodynamics in elderly patients without prolonged extubation and recovery time.