右美托咪啶对老年腹腔镜胃癌根治术患者应激反应与术后认知功能的影响

Effects of dexmedetomidine on stress response and postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy

目的探讨右美托咪啶对老年腹腔镜胃癌根治术患者应激反应与术后认知功能的影响。方法选择2016年1月至2018年10月期间吴川市人民医院收治的102例老年腹腔镜胃癌根治术患者为研究对象,根据随机数表法分为观察组与对照组,每组51例,气管插管、全身麻醉,观察组麻醉中应用右美托咪啶,对照组则不予应用,比较两组患者气管插管前(T0)、气管插管后(T1)、建立气腹时(T2)、拔管时(T3)的血清皮质醇(Cor)、去甲肾上腺素(NE)浓度;术前、术后3 d采用MMSE量表进行评分,比较术后认知功能障碍(POCD)发生率。结果两组患者T1、T2、T3时的血清Cor、NE水平均明显高于T0时,且对照组明显高于观察组,差异均有统计学意义(P<0.05);术后3 d,观察组患者的MMSE评分为(23.99±1.24)分,明显高于对照组的(22.56±1.18)分,差异有统计学意义(P<0.05);观察组患者术后POCD发生率为7.84%,明显低于对照组的17.65%,差异有统计学意义(P<0.05)。结论老年腹腔镜胃癌根治术麻醉时使用右美托咪定可以有效地降低患者的应激反应,保护患者的认知功能,并降低术后认知功能障碍的发生率。

Objective To investigate the effect of dexmedetomidine on stress response and cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. Methods A total of 102 elderly patients with laparoscopic radical gastrectomy from January 2016 to October 2018 treated in Wuchuan People’s Hospital were selected as the study subjects. According to the random number table method, they were divided into observation group and control group, with 51 cases in each group. All patients underwent tracheal intubation and general anesthesia. The observation group used dexmedetomidine in anesthesia, while the control group did not. Serum cortisol(Cor) and norepinephrine(NE) levels were measured between the two groups before tracheal intubation(T0), after tracheal intubation(T1), and at establishment of pneumoperitoneum(T2), extubation(T3). MMSE scale was used before and 3 days after operation to evaluate the incidence of postoperative cognitive dysfunction(POCD). Results The levels of serum Cor and NE at T1,T2 and T3 were significantly higher in the two groups than those at T0, and the levels in the control group was significantly higher than those in the observation group(P<0.05). On the 3 rdday after operation, the MMSE score in the observation group was 23.99±1.24, which was significantly higher than 22.56±1.18 in the control group(P<0.05). The incidence of POCD in the observation group was 7.84%, which was significantly lower than 17.65% in the control group(P<0.05). Conclusion The use of dexmedetomidine during anesthesia for laparoscopic radical gastrectomy in elderly patients can effectively reduce the stress response, protect the cognitive function of patients, and reduce the incidence of cognitive dysfunction after operation.