右美托咪定对胆管结石轻度高胆红素血症患者术后认知功能的影响

Effect of dexmedetomidine on postoperative cognitive function in patients with mild hyperbilirubinemia caused by choledocholithiasis

目的评价右美托咪定对胆管结石轻度高胆红素血症患者术后认知功能的影响。方法择期行胆囊切除术、胆总管探查取石术的胆总管结石轻度高胆红素血症(血清总胆红素21~170μmol/L)患者120例,性别不限,年龄51~63岁,BMI 20~28 kg/m^2,ASA分级Ⅱ或Ⅲ级,术前MMSE评分≥20分。采用随机数字表法将患者分为3组(n=40):对照组(C组)、右美托咪定0.4μg·kg^-1·h^-1组(D1组)和右美托咪定0.6μg·kg^-1·h^-1组(D2组)。D1组和D2组麻醉诱导后经10 min静脉输注右美托咪定负荷剂量0.5μg/kg,随后分别以0.4和0.6μg·kg^-1·h^-1的速率静脉输注至术毕;C组给予等容量生理盐水。分别于术前1d(T0)和术后1、3、5、7 d(T1-4)时采用MMSE评分和MoCA评分评估认知功能,记录术后7 d内认知功能障碍的发生情况。于上述时点采集静脉血样,采用ELISA法测定血浆Aβ42的浓度。结果与C组比较,D1组T1时MoCA评分升高,D2组T1时MMSE评分升高,T1和T2时MoCA评分升高,T2-4时血浆Aβ42浓度降低,D1组和D2组认知功能障碍发生率降低(P<0.05);与D1组比较,D2组T1时MoCA评分升高,T2-4时血浆Aβ42浓度降低(P<0.05)。结论右美托咪定可改善胆管结石轻度高胆红素血症患者术后认知功能,以0.6μg·kg^-1·h^-1的速率静脉输注的效果更佳。

Objective To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis.Methods One hundred and twenty patients of both sexes with mild hyperbilirubinemia(serum total bilirubin levels 21-170μmol/L)caused by choledocholithiasis,aged 51-63 yr,with body mass index of 20-28 kg/m2,of American Society of Anesthesiologists physical statusⅡorⅢ,with preoperative Mini-Mental State Examination(MMSE)scores≥20,scheduled for elective cholecystectomy and choledocholithotomy,were divided into 3 groups(n=40 each)using a random number table method:control group(C group)and dexmedetomindine 0.4μg·kg^-1·h^-1 group(D1 group)and dexmedetomindine 0.6μg·kg^-1·h^-1 group(D2 group).After induction of anesthesia,dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5μg/kg,followed by an infusion of 0.4 and 0.6μg·kg^-1·h^-1 until the end of operation in D1 and D2 groups,respectively.The equal volume of normal saline was given instead in group C.with preoperative scores≥20,MMSE and Montreal Cognitive Assessment(MoCA)were used to assess the cognitive function at 1 day before operation(T0)and 1,3,5 and 7 days after operation(T1-4).The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above,and the plasma concentrations ofβ-amyloid(Aβ)42 were determined by enzyme-linked immunosorbent assay.Results Compared with group C,MoCA scores were significantly increased at T1 in group D1,and MMSE scores at T1 and MoCA scores at T1 and T2 were significantly increased,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2,and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups(P<0.05).Compared with group D1,MoCA scores were significantly increased at T1,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2(P<0.05).Conclusion Dexmedetomidine can improve postoperative cognitive function,and intravenous infusion at a rate of 0.6μg·kg^-1·h^-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.