磷酸肌酸钠复合右美托咪定对老年人全麻术后认知功能的影响

Effect of dexmedetomidine combined with creatine phosphate sodium on postoperative cognitive function in elderly patients after general anesthesia

目的:观察右美托咪定、磷酸肌酸钠、右美托咪定复合磷酸肌酸钠对老年人全麻术后认知功能的影响。方法:选择全麻下食道癌根治术老年病人60例,随机双盲均分为4组:右美托咪定组(D组)、磷酸肌酸钠组(CP组)、右美托咪定复合磷酸肌酸钠组(DCP组)和0. 9%氯化钠注射液空白对照组(C组)。入室后常规监测心电图(ECG)、血压、血氧饱和度(Sp O_2)、呼气末二氧化碳(Pet CO_2)和脑电双频指数(BIS),并分别给予相应药物后开始麻醉,各组麻醉诱导方法及维持用药相同。于麻醉前和术后3 h、1 d、2 d时分别记录简易智力状态检查量表(MMSE)和疼痛视觉模拟评分(VAS)。结果:各组术后各时段VAS评分差异均无统计学意义(P> 0. 05)。C组、D组、CP组在术后3 h、1 d、2 d时的MMSE评分均较术前明显降低(P <0. 01),DCP组MMSE评分在术后3 h较术前明显降低(P <0. 05),术后1 d、2 d时则差异无统计学意义(P> 0. 05); D组、CP组、DCP组MMSE评分在术后各时段均明显高于C组(P <0. 05～P <0. 01),D组、CP组、C组术后各时段术后认知功能障碍的发生率差异均无统计学意义(P> 0. 05),DCP组术后各时段术后认知功能障碍的发生率低于C组(P <0. 05),而和D组、CP组差异无统计学意义(P> 0. 05)。结论:磷酸肌酸钠和右美托咪定均可有效提高老年病人全麻术后认知功能,降低术后认知功能障碍的发生率,两药联用效果更好。

Objective: To observe the effects of dexmedetomidine,creatine phosphate sodium,dexmedetomidine combined with creatine phosphate sodium on postoperative cognitive function in elderly patients after general anesthesia. Methods: Sixty elderly patients treated with esophageal cancer radical surgery under general anesthesia were randomly divided into the dexmedetomidine group( group D),creatine phosphate sodium group( group CP),dexmedetomidine combined with creatine phosphate sodium group( group DCP) and0. 9% sodium chloride injection blank control group( group C). The ECG,BP,Sp O2,Pet CO2 and BIS in four groups were monitored.After starting anesthesia,the anesthesia induction and maintenance in four groups were the same. The MMSE and VAS scores in four groups were recorded before anesthesia,and after 3 h,1 d and 2 d of surgery. Results: There was no statistical significance in VAS scores among four groups at each time period( P > 0. 05). The MMSE scores in groups C,D and CP after 3 h,1 d and 2 d of surgery were significantly lower than those before surgery( P < 0. 01). The MMSE score in group DCP after 3 h of surgery was significantly lower than that before surgery( P < 0. 05),and the difference of which between postoperative 1 d and 2 d was not statistically significant( P >0. 05). The MMSE scores in groups D,CP and DCP were significantly higher than those in group C after operaation( P < 0. 05 to P <0. 01). The differences of the incidence rate of postoperative cognitive dysfunction among groups D,CP,C were not statistically significant after operation( P > 0. 05). The incidence rate of postoperative cognitive dysfunction in group DCP after surgery was lower than that in group C( P < 0. 05),but the difference of which between group DCP and group C or group D was not statistically significant( P > 0. 05). Conclusions: Creatine phosphate sodium dexmedetomidine can effectively improve cognitive function,and reduce the incidence rate of postoperative cognitive dysfunction in elderly patients after general anesthesia. The effect of combination of two drugs is better.