右美托咪定对老年患者腹部手术围术期认知功能、血流动力学和免疫功能的影响

Effects of dexmedetomidine on cognitive function, hemodynamics and immune function in elderly patients during perioperative period of abdominal surgery

目的探讨右美托咪定对老年患者腹部手术围术期认知功能、血流动力学和免疫功能的影响。方法选择2017年1月至2018年12月在中国科学技术大学附属第一医院/安徽省立医院行腹腔镜手术的患者80例,采用随机数字表法分为对照组和观察组,每组40例。对照组患者给予丙泊酚、瑞芬太尼,麻醉诱导剂量分别为1.5~2.0mg/kg、2~4μg/kg;麻醉维持剂量为100μg/(kg·min)、0.5~2.0μg/(kg·min)。观察组患者在对照组基础上给予右美托咪定,麻醉诱导剂量为0.5μg/kg,麻醉维持剂量为0.4μg/(kg·h)。采用简易智力状态检查量表(mini-mental state examination,MMSE)评价认知功能及术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率。采用阻抗法检测中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP),并计算波动值。采用流式细胞仪检测T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)。结果观察组患者术后MMSE评分明显高于对照组,POCD的发生率明显低于对照组,差异均有显著性(P<0.05)。观察组患者麻醉过程中血流动力学指标CVP、HR、MAP波动明显小于对照组,差异有显著性(P<0.05)。观察组患者CD3^+、CD4^+、T淋巴细胞计数及CD4/CD8比值均明显高于对照组,差异有显著性(P<0.05)。结论右美托咪定可有效减少老年患者腹部手术后POCD的发生,且具有稳定血流动力学、改善免疫功能的作用。

Objective To investigate the effects of dexmedetomidine(DEX) on cognitive function, hemodynamics and immune function in elderly patients during perioperative period of abdominal surgery. Method The patients in the control group were given propofol and remifentanil at the induction doses of 1.5-2.0 mg/kg and 2-4μg/kg, respectively, and the maintenance doses of anesthesia were 100μg/(kg·min) and 0.5-2.0μg/(kg·min). The patients in the observation group were given DEX anesthesia induction dose of 0.5μg/kg and maintenance dose of 0.4μg/(kg·h) on the basis of the control group. Mini-mental state examination(MMSE) was used to evaluate the cognitive function and the incidence of POCD. Central venous pressure(CVP), heart rate(HR), mean arterial pressure(MAP) were measured by impedance method, and the fluctuation values were calculated. T lymphocyte subsets(CD3^+, CD4^+, CD8^+) were detected by flow cytometry. Result The MMSE score of the observation group was significantly higher than that of the control group, while the incidence of POCD of the observation group was significantly lower than that of the control group, the difference was statistically significant(P<0.05). The fluctuations of CVP, HR and MAP in the observation group during anesthesia were significantly lower than those in the control group(P<0.05). The levels of CD3^+, CD4^+, CD8^+ T lymphocyte and CD4/CD8 ratio in the observation group were significantly higher than those in the control group(P<0.05). Conclusion DEX can effectively reduce the incidence of POCD in elderly patients after abdominal surgery, and has the effect of stabilizing hemodynamics and improving immune function.