右美托咪定对老年胸腔镜手术患者谵妄的影响及机制

Effect and mechanism of dexmedetomidine on postoperative delirium in elderly patients undergoing thoracoscopic surgery

目的探讨右美托咪定对老年胸腔镜手术患者谵妄的影响及机制。方法选择2015年1月～2017年1月于我院治疗的120例老年胸腔镜手术患者,数字随机法均分为观察组与对照组两组,每组各60例。两组均采用常规全麻手术,术中给予脑氧饱和度监测,观察组在此基础上麻醉诱导前按0.5μg/kg给予右美托咪定维持注射15min,随后持续输注,剂量0.3～0.5/μg(kg·h),直至手术结束前30min停止输注;对照组给予相同剂量的生理盐水。比较诱导前(T0)、插管前(T1)、单肺通气前(T2)、单肺通气结束(T3)、拔管前(T4)、拔管后5min(T5)平均动脉压(MAP)、脑氧饱和度(rSO_2),记录手术时间以及麻醉药物用量。采用参照DSM-Ⅳ谵妄/意识错乱评价标准诊断术后谵妄发生情况;检测麻醉前、手术结束时、术后1d、3d血清s-100β蛋白水平、脑氧饱和度(rSO_2)。结果两组芬太尼、丙泊酚、顺苯磺酸阿曲库铵、七氟醚用量以及手术时间比较差异无统计学意义(P>0.05);观察组瑞芬太尼使用量小于对照组(P<0.05);观察组T3rSO_2高于对照组,T2 MAP低于对照组(P<0.05);观察组术后谵妄发生率低于对照组(P<0.05);观察组手术结束时、术后1d、3d血清s-100β水平均低于对照组(P<0.05);观察组术中平均rSO_2高于对照组(P<0.05)。结论右美托咪定能降低术后谵妄发生率,降低血清s-100β水平,能改善术中脑氧代谢。

Objective To study effect and mechanism of dexmedetomidine on postoperative delirium in elderly patients undergoing thoracoscopic surgery.Methods 120 elderly patients undergoing thoracoscopic surgery in our hospital from January 2015 to January 2017 were selected.The patients were divided into the control group and the observation group randomly,according to the digital random method.The two groups of patients were given the monitoring of oxygen saturation under general anesthesia.And the observation group was given dexmedetomidine for injection of 15min at 0.5 micron g/kg before the induction of anesthesia,followed by continuous infusion of 0.3 ~ 0.5 μg/kg/h and 30min stopped infusion until the end of operation.The control group was given the same dose of physiological saline.Before induction(T0),before intubation (T1),one lung ventilation (T2),before the end of one lung ventilation (T3),before extubation (T4),5min after extubation (T5) mean arterial pressure (mean arterial pressure,MAP),cerebral oxygen saturation (Cerebral regional oxygen saturation,rSO2) were compared.Record the time of operation and the dosage of narcotic drugs.At the end of the operation,and after the operation of 1D and 3D serum S-100 beta protein levels were detected at the end of the anesthesia according to the DSM-IV delirium / delirium evaluation criteria for the diagnosis of postoperative delirium.Then the serum s-100β protein level and cerebral regional oxygen saturation (rSO2) of the two groups were compared.Results Fentanyl,propofol,atracurium perphenol sulfonic acid,sevoflurane,and the difference of operation time were no statistically significant in two groups(P>0.05).The usage remifentanil was lower in observation group than that in the control group(P<0.05).T3rSO2 was significantly higher in observation group than that in the control group,and T2 MAP was lower in observation group than that in the control group(P<0.05).Incidence of delirium was 4.66% after operation in observation group,and lower than this in control group(15.00%)(P<0.05).The serum s-100β levels in the observation group at the end of surgery and 1 d and 3 d after operation were significantly lower than those in the control group (P<0.05).The mean rSO2 in the observation group was significantly higher than that in the control group (P<0.05).Conclusion Dexmedetomidine on Monitoring of cerebral oxygen saturation can significantly decrease the incidence of postoperative delirium,reduce the level of serum S-100 beta and improve the metabolism of brain oxygen in the operation.