右美托咪定对老年脊柱手术患者围术期应激反应及术后认知的影响

Effect of dexmedetomidine on the perioperative stress response and postoperative cognition in the elderly patients receiving spinal surgery

目的观察右美托咪定对老年脊柱手术患者围术期应激反应及术后认知功能的影响。方法入选河北北方学院附属第一医院麻醉科2016年4月至2017年11月择期实施脊柱手术的老年患者120例,随机数字表法分为右美托咪定组和生理盐水组,每组60例。右美托咪定组患者建立静脉通路后即刻静脉泵注负荷剂量0.5μg/kg的右美托咪定,持续输注10 min,然后以0.3μg/(kg·h)的速度持续泵注到手术结束前30 min。生理盐水组患者建立静脉通路后给予等容量生理盐水。比较2组患者T_0(术前1 d)、T_1(术后4 h)、T_2(术后24 h)和T_3(术后48 h)时间点应激反应因子水平及认知功能。应用SPSS 19.0统计软件对数据进行分析。组间比较采用重复测量的方差分析和t检验。结果 2组患者术后T_1和T_2时间点皮质醇和白介素-6(IL-6)水平相比T_0时间点水平升高,血管紧张素Ⅱ(AnⅡ)水平较T_0时间点下降,且生理盐水组相比右美托咪定组患者T_1和T_2时间点皮质醇、IL-6和AnⅡ水平均高,差异均具有统计学意义(P<0.05)。2组患者T_1、T_2时间点简易认知功能评估(MMSE)量表评分低于T_0时间点,匹茨堡睡眠质量指数(PSQI)量表评分高于T_0时间点,且右美托咪定组相比生理盐水组患者MMSE评分T_1时间点[(25. 34±2. 64) vs (20. 01±2. 01)分]和T_2时间点[(25. 45±2. 71) vs (21. 12±2. 14)分]高,PSQI评分T_1时间点[(7. 67±1. 25) vs (9. 68±1. 23)分]和T_2时间点[(2. 86±1. 53) vs (2. 99±1. 55)分]低,差异具有统计学意义(P<0. 05)。结论右美托咪定应用于老年脊柱手术患者,可有效降低围术期应激反应及术后认知功能障碍。

Objective To investigate the effect of dexmedetomidine on the perioperative stress response and postoperative cognition in the elderly patients undergoing spinal surgery.Methods A total of 120 elderly patients were selected for the study,who received spinal surgery in the Department of Anesthesiology of the First Affiliated Hospital of Hebei North University from April 2016 to November 2017.They were randomly divided into dexmedetomidine group(group D)and normal saline group(group S)with 60 each.Venous access was established in both groups.In group D,a loading dose of dexmedetomidine was pumped at 0.5μg/kg for 10 min,and dexmedetomidine was continuously pumped at 0.3μg/(kg·h)until 30 min before the end of the operation.In group S,saline of the equal volume was given via intravenous infusion.The levels of stress factors and cognitive function were compared between two groups at T 0(1 d before operation),T 1(4 h after operation),T 2(24 h after operation)and T 3(48 h after operation).SPSS statistics 19.0 was used for data analysis,and repeated measures analysis of variance and Student′s t test were performed for comparison between groups.Results Cortisol and interleukin-6(IL-6)in both groups at T 1 and T 2 were higher but angiotensinⅡ(AngⅡ)at those time points was lower than at T 0.Group S had higher cortisol,IL-6 and AngⅡthan group D at T 1 and T 2,the difference being statistically significant(P<0.05).For both groups,MMSE scores were lower at T 1 and T 2 than at T 0.Compared with group S,group D had higher MMSE scores at T 1[(25.34±2.64)vs(20.01±2.01)]and T 2[(25.45±2.71)vs(21.12±2.14)]but lower PSQI scores at T 1[(7.67±1.25)vs(9.68±1.23)]and T 2[(2.86±1.53)vs(2.99±1.55)],the difference being statistically significant(P<0.05).Conclusion Dexmedetomidine has effect in alleviating perioperative stress response and postoperative cognitive dysfunction in the elderly patients with spinal surgery.