围麻醉期右美托咪定的应用对老年患者PFN术后认知功能障碍的影响

Effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia

目的研究围麻醉期右美托咪定(Dex)的应用对老年患者股骨粗隆间骨折行髓内钉(PFN)术后认知功能障碍(POCD)的影响。方法选取2018年1~12月广州市第一人民医院南沙医院收治的股骨粗隆间骨折,在椎管内麻醉下择期行PFN手术的老年患者60例为研究对象,采用随机数字表法分为Dex组(D组,n=30)和对照组(C组,n=30)。D组患者麻醉前15 min静脉泵注Dex 0.3μg/kg作为术前用药,10 min泵注完,术中泵注Dex 0.3μg/(kg·h)至术终,术后Dex 1μg/(kg·d)+舒芬太尼2μg/(kg·d)行PCIA 48 h;C组患者围麻醉期静脉泵注生理盐水,术后舒芬太尼2μg/(kg·d)行PCIA。检测麻醉前(T0)、术后24 h(T1)、术后48 h(T_2)血清丙二醛(MDA)、8-异构前列腺素F2α(8-iso PGF2α)水平,并行简易精神状态评价量表(MMSE)评分。结果两组患者T1、T_2的MDA、8-iso PGF2α水平高于T0,但D组低于C组同时点,差异有统计学意义(P <0.05)。两组患者T1、T_2的MMSE评分低于T0,但D组高于C组同时点,差异有统计学意义(P <0.05)。C组T1和T_2的VAS高于D组,按压次数、有效按压次数、舒芬太尼用量多于D组,差异有统计学意义(P <0.05)。结论围麻醉期应用Dex,可降低老年患者PFN术后POCD的发生率。

Objective To study the effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia. Methods Sixty elderly scheduled for PFN surgery under spinal anesthesia were enrolled in Nansha Hospital of the First People′s Hospital of Guangzhou City from January to December 2018 were selected as study objects, and they were divided into Dexmedetomidine group (group D, n = 30) and control group (Group C, n = 30) by using random numeral table method. The patients in group D were intravenous infused 0.3 μg/kg Dexmedetomidine within 10 min as premedication 15 minutes before anesthesia, followed by 0.3 μg/(kg·h) infusion until the end of operation. The patients in group C received intravenous infusion of saline. Patient-controlled intravenous analgesia (PCIA) was started for all patients when they were transferred to the ward. The patients were given Sufentanyl 2 μg/(kg·d) as PCIA 100 mL in group C. Group D were given Dexmedetomidine 1 μg/(kg·d)+ Sufentanyl 2 μg/(kg·d) as PCIA 100 mL. The levels of MDA and 8-iso PGF2α in serum were detected before anesthesia (T0), 24 h (T1) and 48 h (T2) after operation. The min-mental state examination (MMSE) scores were estimated at T0, T1 and T2. Results The levels of MDA and 8-iso PGF2α at T1 and T2 in two groups were higher than those at T0, but those in group D were lower than those in group C at the same time, the differences were statistically significant (P < 0.05). MMSE scores of T1 and T2 in two groups were lower than those of T0, but those in group D were higher than those in group C at the same time, the differences were statistically significant (P < 0.05). VAS of T1 and T2 in group C was higher than that in group D, and the times of pressing, effective pressing and the dosage of Sufentanil in group C were higher than those in group D, the differences were statistically significant (P < 0.05). Conclusion Dexmedetomidine can reduce the incidence of postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia.