右美托咪定对老年腹腔镜肾癌根治术患者术后认知功能和炎症的影响

Effects of Dexmedetomidine on Postoperative Cognitive Function and Inflammation in Elderly Patients with Renal Cancer after Laparoscopic Radical Nephrectomy

目的研究分析右美托咪定(DEX)对行腹腔镜肾癌根治术老年患者术后认知功能和炎症的影响。方法纳入2016年6月—12月拟行腹腔镜肾癌根治术的78例老年患者为研究对象,根据麻醉方式的不同分为观察组和对照组,每组39例。观察组麻醉诱导前给予DEX静脉泵注,对照组给予等量生理盐水。观察两组手术结束时(T0)、苏醒时(T1)和拔管后(T2)的平均动脉压(MAP)及心率、脑电双频指数(BIS)。在术前及术后1、3 d运用简明智能状态量表(MMSE)对患者进行认知功能评估,检测白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平,并观察不良反应发生状况。结果术后1和3 d,观察组MMSE评分显著高于对照组(P<0.05),IL-6、TNF-α及CRP水平低于对照组(P<0.05)。对照组术后1和3 d的MMSE评分低于术前(P<0.05),IL-6、TNF-α及CRP水平高于术前(P<0.05);观察组术后1 d的MMSE评分低于术前(P<0.05),IL-6、TNF-α及CRP水平高于术前(P<0.05)。T1和T2时,观察组MAP和心率均低于对照组(P<0.05)。所有患者均未出现明显的不良反应。结论DEX可有效地降低行腹腔镜肾癌根治术老年患者的炎性因子水平,并促进患者术后认知功能的恢复。

Objective To investigate effects of Dexmedetomidine(DEX)on postoperative cognitive function and inflammation in elderly patients with renal cancer after laparoscopic radical nephrectomy.Methods A total of78elderly patients with renal cancer,who would undergo laparoscopic radical nephrectomy from June to December2016,were recruited in this study,and the patients were divided into observation group(n=39)and control group(n=39)according to different anaesthetic methods.Observation group was treated with DEX by intravenous injection before anesthesia induction,while control group was treated with the same volume of physiological saline.The mean arterial pressure(MAP),heart rate and bispectral index(BIS)were observed at the time of operation ending(T0),at the time of palinesthesia(T1)and after extubation(T2)in two groups.Before operation and at the1st and3rd d after operation,conditions of cognitive function were evaluated by mini-mental state examination(MMSE)scale,and levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)were detected,and then incidence rate of adverse reactions were observed.Results At the1st and3rd d after operation,in observation group,MMSE scores were significantly higher(P<0.05),while IL-6,TNF-αand CRP levels were significantly lower than those in control group(P<0.05).In control group at the1st and3rd d after operation,MMSE scores were significantly lower(P<0.05),while IL-6,TNF-αand CRP levels were significantly higher than those before operation(P<0.05).In observation group at the1st d after operation,MMSE score was significantly lower(P<0.05),while IL-6,TNF-αand CRP levels were significantly higher than those before operation(P<0.05).At T1and T2,values of MAP and heart rate in observation group were significantly lower than those in control group(P<0.05).No obvious adverse reactions were found in all patients.Conclusion DEX may effectively reduce level of inflammatory factors in elderly patients with renal cancer after laparoscopic radical nephrectomy and promote postoperative recovery of cognitive function.