右美托咪定对腔隙性脑梗死患者术后谵妄的影响

Effect of dexmedetomidine on postoperative delirium in lacunar infarction patients

目的 评价右美托咪定对腔隙性脑梗死患者术后谵妄的影响。方法 择期行髋关节置换术的腔隙性脑梗死患者60例,分为2组(n=30):右美托咪定组(D组),对照组(C组)。D组于麻醉诱导后持续静脉泵注右美托咪定0.5μg·kg^-1·h^-1至术毕,C组泵注等容量生理盐水。于麻醉诱导前(T0)、术毕(T1)和术后24h(T2)抽取颈内静脉球部血样,采用ELISA法测定血清S100β蛋白和脑源性神经营养因子(BDNF)的浓度,并评估术后3d内谵妄发生率、发生时间及持续时间。结果 与C组比较,D组T1、T2时S100β降低(P<0.05),BDNF升高(P<0.05),与T0时比较,2组T1、T2时血清S100β蛋白浓度升高(P<0.05),BDNF浓度降低(P<0.05)。D组术后谵妄发生率降低,术后谵妄发生的时间推迟(P<0.05)以及术后谵妄持续时间缩短(P<0.05)。结论 右美托咪定可减轻腔隙性脑梗死患者脑损伤,预防和改善术后谵妄。

Objective To evaluate the effect of dexmedetomidine on postoperative delirium (POD) in lacunar infarction patients. Methods Sixty patients with lacunar infarction,scheduled for elective artificial hip replacement,were randomly divided into 2 groups ( n =30):group D,0.5 μg·kg ^-1 ·h^-1 dexmedetomidine injected from anesthesia induction to the end of surgical operation,group C,give the same volume of normal saline instead.Blood samples were collected from the jugular bulb before anesthesia induction (T0) and at the end of surgery(T1),24 hours after the surgery(T2),S100β protein and brain derived neurotrophic factor (BDNF) in serum were measured by enzyme linked immunosorbent assay.Evaluate the incidence,the onset time and duration of POD within 3 days after surgical operation. Results Compared with group C,S100β were decreased ( P <0.05) and BDNF were increased ( P <0.05) at T1 T2.Compared with group T0,S100β were increased ( P <0.05) and BDNF were decreased ( P <0.05) at T1 T2.The incidence of POD in group D was decreased,in group D the onset time of delirium was delate ( P <0.05) and duration of delirium was shorten( P <0.05). Conclusion Dexmedetomidine can reducing patients with lacunar infarction brain injury and prevent the development of POD.