右美托咪定复合芬太尼对老年肱骨干骨折患者脑氧饱和度及术后早期认知功能的影响

Effects of dexmedetomidine combined with fentanyl on cerebral oxygen saturation and early postoperative cognitive function in the elderly patients with humeral shaft fracture

目的分析右美托咪定复合芬太尼用于老年肱骨干骨折患者麻醉后脑氧饱和度及早期术后认知功能的变化。方法回顾性分析2013年3月至2016年12月期间深圳市龙岗区第二人民医院麻醉科因肱骨干骨折手术的老年患者272例,根据麻醉方式不同分为研究组(右美托咪定复合芬太尼全麻)和对照组(采用七氟醚-瑞芬太尼静吸复合麻醉),每组136例,比较2组患者入室(T1)、麻醉准备(T2)、手术30 min(T3)、手术结束(T4)4个时间点脑氧饱和度,以及治疗前1 d、治疗后1 d和3 d韦氏成人智力量表(WAIS-RC)各指标得分。应用SPSS 22. 0统计软件对数据进行分析。组间比较采用t检验、方差分析或χ2检验。结果研究组患者的睁眼时间、苏醒评分、拔管时间、复苏室停留时间、心率、呼吸频率、平均动脉压以及疼痛程度评分均明显优于对照组患者,差异具有统计学意义(P <0. 05)。对照组不同时点脑氧饱和度差异无统计学意义(F=2. 04,P=0. 11),研究组不同时点脑氧饱和度差异有统计学意义(F=41. 57,P=0. 00)。研究组相比对照组患者T2[(64. 82±9. 87)%vs (72. 56±9. 80)%]、T3 [(62. 03±11. 05)%vs (70. 23±11. 25)%]和T4 [(69. 20±9. 47)%vs(72. 47±9. 88)%]时间点脑氧饱和度低,差异具有统计学意义(P <0. 05)。研究组患者麻醉后1 d和3 d的常识、领悟、算术、相似、数字广度、填图、木块图、图片排列、图形拼凑得分低于对照组患者,差异具有统计学意义(P <0. 05)。结论右美托咪定复合芬太尼降低患者认知功能和脑氧饱和度的时限较短,具备一定的用药安全性,可用于老年肱骨干骨折患者,术中应密切观察并稳定患者的脑氧饱和度。

Objective To analyze the changes of cerebral oxygen saturation and cognitive function after anesthesia in the elderly patients with humeral shaft fracture treated with dexmetomidine and fentanyl. Methods A retrospective analysis was made of 272 elderly patients with humeral shaft fractures in the Department of Anesthesiology, the Second People′s Hospital of Longgang District in Shenzhen from March 2013 to December 2016. According to the anesthesia type, they were divided into study group （dexmetomidine-fentanyl） and control group （sevoflurane-remifentanil） with 136 patients each. The 2 groups were compared in cerebral oxygen saturation at admission into operating room （T1）, anesthesia preparation （T2）, 30 min into the operation （T3） and the end of operation （T4） and in scores of Wechsler Adult Intelligence scale （WAIS-RC） at preoperative day 1 and postoperative day 1 and day 3. The data were analyzed with SPSS 22.0. Student′s t test, ANOVA or χ 2 test was employed for intergroup comparison. Results The study group were significantly better than the control group in terms of blink time, awakening, extubation time, time in resuscitation room, heart rate, respiratory frequency, mean arterial pressure and pain. The difference was statistically significant （ P 〈0.05）. The control group had no significant difference in cerebral oxygen saturation at different time points （ F=2.04, P =0.11）, but the study group had significant difference in the terms （ F=41.57, P =0.00）. Compared with the control group, the study group had lower cerebral oxygen saturation at T2 [（64.82±9.87）% vs （72.56±9.80）%], T3 [（62.03±11.05）% vs （70.23±11.25）%], and T4 [（69.20±9.47）% vs （72.47±9.88）%], with statistically significant difference （ P 〈0.05）. The study group scored lower than the control group in common sense, understanding, arithmetics, similarity, digit span, filling in the chart, block diagram, picture arrangement and graphic patchwork at postoperative day 1 and day 3, the difference being statically significant （ P 〈0.05）. Conclusion Dexmetomidine- fentanyl , with short-term reduction of cognitive function and cerebral oxygen saturation, can be a safe option for the treatment of humeral shaft fracture in the elderly patients, and it is necessary to observe and stabilize cerebral oxygen saturation in the procedure.