老年全麻患者应用右美托咪定对其术后认知功能的影响

Effect of dexmedetomidine on postoperative cognitive function in elderly patients with general anesthesia

目的探讨全麻过程中联合右美托咪定对老年患者术后早期认知功能影响。方法选取2016年1月～2018年7月行全麻手术老年患者82例,随机分为观察组(n=41)及对照组(n=41),全部实施气管插管全身麻醉,观察组联合右美托咪定持续静脉注射,0.3μg/(kg·h),术毕前半小时停止,对照组全麻术后予以等量生理盐水静脉注射。观察指标包括恢复自主呼吸时间、拔管时间、麻醉药物用量、术后认知功能情况。结果观察组应用丙泊酚总量(234.22±35.63)mg、芬太尼总量(0.35±0.11)mg、恢复自主呼吸(6.12±2.88)min、拔管时间(19.86±3.69)min均少于对照组(378.29±67.21)mg、(0.46±0.14)mg、(9.80±3.12)min、(26.34±4.05)min(P <0.05);观察组术后1 d MMSE(24.60±1.22)、3 d(26.98±1.03)高于对照组的(22.87±1.08)、(26.15±1.03)(P <0.05);术后认知功能障碍7.32%低于对照组19.51%(P <O.05)。结论老年全身麻醉患者联合右美托咪定进行麻醉,手术后认知功能可良好的恢复,同时减少全麻药物用量。

Objective To investigate the effect of dexmedetomidine combined with general anesthesia on early postoperative cognitive function.Methods From January 2016 to July 2018,82 elderly patients underwent general anesthesia in our hospital were randomly divided into observation group(n=41)and control group(n=41).Tracheal intubation and general anesthesia were all performed,the observation group was given continuous intravenous injection of dexmedetomidine,0.3 g/kg h,half an hour before the end of the operation.The control group was given equal amount of normal saline intravenously after general anesthesia.Observation indicators include:recovery of spontaneous breathing time,extubation time,dosage of narcotic drugs,postoperative cognitive function.Results The dose of propofol in the observation group was(234.22±35.63)mg,fentanyl was(0.35±0.11)mg,recovery of spontaneous breathing was(6.12±2.88)min,extubation time was(19.86±3.69)minutes,which were less than those of the control group(378.29±67.21)mg,(0.46±0.14)mg,(9.80±3.12)min,(26.34±4.05)min(t=6.25,5.26,4.23,3.76,P<0.05).The observation group MMSE was(24.60±1.22)at 1 days after operation,(26.98±1.03)of 3 days,which were higher than those of the control group(22.87±1.08)and(26.15±1.03)(t=3.14,3.28,P<0.05).Postoperative cognitive impairment was 7.32%,lower than that of control group 19.51%(χ^2=4.25,P<0.05).Conclusion The elderly patients under general anesthesia with dexmedetomidine could help to restore the postoperative cognitive function well and reduce the dosage of general anesthetics.