右美托咪定对腹腔镜全子宫切除术患者早期认知功能及TNF-α的影响

Effects of dexmedetomidine on early cognitive function and expression of tumor necrosis factor-α in laparoscopic hysterectomy patients

目的:探讨右美托咪定对腹腔镜全子宫切除术患者早期认知功能及肿瘤坏死因子-α(TNF-α)的影响。方法:选取择期全身麻醉下行腹腔镜全子宫切除术的60例患者(45~60岁,ASAⅠ~Ⅱ级),随机分为对照组与右美托咪定组(观察组),每组30例。观察组于麻醉诱导前15 min静脉持续泵注右美托咪定1.0μg/kg,然后以0.5μg/kg·h^-1持续泵注至术毕前30 min;对照组患者泵注等量生理盐水。分别于术前1 d(T 0)及术后第1天(T 1)、第2天(T 2)、第3天(T 3)采集患者外周静脉血,采用ELISA法测定血清中TNF-α水平,同时采用简易精神状态评价量表(MMSE)评价认知功能。结果:与T 0相比,T 1~T 3时,两组患者MMSE评分降低(P<0.05),血清TNF-α浓度升高(P<0.05)。与对照组相比,观察组患者T 1~T 3时血清TNF-α水平降低(P<0.05)。T 3时,两组患者术后认知功能障碍发生率分别为36.67%与13.33%,两组差异有统计学意义(P<0.05)。结论:右美托咪定能降低腹腔镜全子宫切除术患者术后早期认知功能障碍发生率,下调血清TNF-α水平表达。

Objective:To investigate the effects of dexmedetomidine on early cognitive function and tumor necrosis factor-α(TNF-α)in laparoscopic hysterectomy patients.Methods:Sixty cases of laparoscopic hysterectomy under elective general anesthesia were selected,patients aged 45-60,with ASA gradeⅠ-Ⅱ.They were randomly divided into control group and dexmedetomidine group,with 30 cases in each group.The patients of dexmedetomidine group received intravenous dexmedetomidine(1.0μg/kg)over 15 min before induction of anesthesia,followed by a continuous dexmedetomidine infusion(0.5μg/kg·h^-1)until 30 min before the end of the operation;the control group was given normal saline with the same dosage as dexmedetomidine group.Blood samples were collected from the patients at different time points:1 day before operation(T 0),postoperative 1 day(T 1),postoperative 2 days(T 2),postoperative 3 days(T 3).Then,TNF-αlevels were measured by ELISA and the cognitive function was assessed by mini-mental state examination(MMSE).Results:The MMSE scores obtained at T 1,T 2 and T 3 in two groups were lower than those at T 0,however,the TNF-αlevels were significantly higher at T 1,T 2 and T 3 than at T 0(P<0.05).Compared with control group,the TNF-αlevels in dexmedetomidine group were significantly lower at T 1,T 2 and T 3(P<0.05).The incidence of postoperative cognitive dysfunction was 36.67%in control group and 13.33%in dexmedetomidine group at T 3,respectively.There was significant difference between the two groups(P<0.05).Conclusions:Dexmedetomidine could reduce the incidence of the early cognitive disfunction in laparoscopic hysterectomy patients and down-regulate the expression levels of TNF-α.