右美托咪定改善缺血性脑血管病患者术后认知功能障碍和注意网络功能的临床研究

Effects of dexmedetomidine on cognitive dysfunction and attentional network function in patients with ischemic cerebrovascular disease

目的:观察右美托咪定对缺血性脑血管病患者术后认知功能障碍和注意网络功能的影响。方法:选取本院2015年9月至2018年2月收治的86例全麻下行神经介入手术的缺血性脑血管病患者,随机分为观察组与对照组,各43例。观察组于麻醉前静脉泵注右美托咪定,对照组泵注相同剂量的生理盐水。比较两组术前(T0)、插管后(T1)、手术开始30 min(T2)、术毕(T3)等时刻的心率(HR)、收缩压(SBP)、舒张压(DBP),术前、术后6 h、术后24 h、术后72 h、术后1周的认知功能(采用MMSE量表评估)、POCD发生率、术前与术后72 h的注意网络功能(包括警觉网络效率、定向网络效率、执行控制网络效率、平均反应时间、正确率)。结果:两组术中T1、T2时刻的HR、SBP与DBP均较术前显著降低( P < 0.05 ),至T3时刻恢复至术前相当的水平( P > 0.05 )。观察组术中T1与T2时刻的HR 显著低于对照组、SBP与DBP显著高于对照组( P < 0.05 )。观察组术后1周内的POCD累计发生率为 9.30%,显著低于对照组的 27.91%( P < 0.05 )。观察组术后6 h、术后24 h的MMSE评分显著低于术前( P < 0.05 ),至术后72 h开始恢复至与术前相当水平( P > 0.05 );对照组术后6 h、术后24 h、术后72 h的MMSE评分显著低于术前( P < 0.05 ),术后1周时的MMSE评分恢复至术前水平( P > 0.05 )。观察组术后6 h、术后24 h的MMSE评分显著高于对照组( P < 0.05 )。两组术后3 d的警觉网络效率、定向网络效率、正确率均较术前1 d显著减小( P < 0.05 )、执行控制网络效率、平均反应时间均较术前1 d显著增大( P < 0.05 )。观察组术后3 d的警觉网络效率、定向网络效率、正确率显著高于对照组、执行控制网络效率、平均反应时间显著低于对照组( P < 0.05 )。结论:右美托咪定可减慢心率并减轻血流动力学波动,改善缺血性脑血管病患者术后认知功能与注意网络功能。

AIM : To observe the effects of dexmedetomidine on postoperative cognitive dysfunction and attention network function in patients with ischemic cerebrovascular disease. METHODS : A total of eighty-six patients with ischemic cerebrovascular disease who were admitted to our hospital from September 2015 to February 2018 were randomly divided into observation group and control group, with 43 cases in each group. In the observation group, dexmedetomidine was pumped intravenously before anesthesia, and the same dose of saline was pumped into the control group. The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before operation (T0), after cannulation (T1), 30 min after operation(T2), end of surgery(T3), the cognitive function before operation, 6 h after operation, 24 h after operation, 72 h after operation, and 1 week after operation (assessed using MMSE scale), incidence of POCD, the attention network function (including alerting network efficiency, orienting network efficiency, executive control network efficiency, average response time, and accuracy) before operation and 72 h after operation were compared between the two groups. RESULTS :The HR, SBP and DBP at T1 and T2 in both groups were significantly lower than before surgery ( P < 0.05 ), and returned to the preoperative equivalent level at T3 ( P > 0.05 ). The HR at T1 and T2 in the observation group was significantly lower than that in the control group, and the SBP and DBP were significantly higher than those in the control group ( P < 0.05 ). The cumulative incidence of POCD in the observation group within 1 week after surgery was 9.30%, which was significantly lower than 27.91% in the control group ( P < 0.05 ). The MMSE scores of the observation group at 6 hours and 24 hours after operation were significantly lower than that before operation( P < 0.05 ), and recovered to the preoperative level at 72 hours after operation( P > 0.05 ). The MMSE scores of the control group at 6 hours, 24 hours, and 72 hours after operation were significantly lower than that before the operation ( P < 0.05 ). The MMSE score at one week after operation returned to the preoperative level ( P > 0.05 ). The alerting network efficiency, orienting network efficiency, and correct rate at 3 d after surgery of the two groups were significantly reduced than 1 d before surgery ( P < 0.05 ), the executive control network efficiency, and the average response time were significantly higher than 1 d before surgery ( P < 0.05 ). The alerting network efficiency, orienting network efficiency and accuracy of the observation group at 3 d after operation were significantly higher than those of the control group, and the executive control network efficiency and the average response time were significantly lower than those of the control group ( P < 0.05 ). CONCLUSION :The dexmedetomidine can slow down heart rate and reduce hemodynamic fluctuations, improve postoperative cognitive function and attention network function in patients with ischemic cerebrovascular disease.