右美托咪定对老年冠心病CABG术患者应激反应及认知功能的影响

Effects of dexmedetomidine on stress response and cognitive function in elderly patients with coronary heart disease undergoing coronary artery bypass grafting

目的探究右美托咪定对拟行冠状动脉旁路移植术(CABG)的老年冠心病患者应激反应及认知功能的影响。方法选取深圳市人民医院2016年12月至2019年1月收治的98例行CABG术的老年冠心病患者作为研究对象,按随机数表法将其分为观察组和对照组各49例。所有患者进行麻醉诱导和气管插管后,观察组给予0.4μg/(kg·h)右美托咪定对患者持续泵注,对照组则采用相同剂量生理盐水作为安慰剂静脉滴注。比较两组患者术后12 h的应激激素血管紧张素Ⅱ(AngⅡ)水平和皮质醇水平,同时采用简易精神状态量表(MMSE)评价患者的认知功能,记录并比较两组患者术后MMSE评分情况以及术后认知功能障碍(POCD)发生情况。结果经比较,两组患者的术前AngⅡ水平和皮质醇水平差异均无统计学意义(P>0.05);观察组患者术后6 h的AngⅡ水平和皮质醇水平分别为(40.13±9.29)ng/L、(75.60±12.88)mol/L,明显低于对照组的(57.67±10.18)ng/L、(89.33±15.61)mol/L,差异均具有统计学意义(P<0.05);术前1 d,观察组患者的MMSE评分为(28.38±0.15)分,与对照组的(28.33±0.16)分比较差异无统计学意义(P>0.05);在术后1 d、3 d、7 d三个时段中,观察组患者的MMSE评分分别为(24.31±0.88)分、(26.46±1.01)分和(28.20±0.44)分,显著高于对照组的(21.58±1.21)分、(23.75±0.98)分和(26.81±0.52)分,差异均具有统计学意义(P<0.05);术后1 d和术后2 d,观察组患者发生POCD的比例为6.12%和2.04%,显著少于对照组的20.41%和16.33%,差异有统计学意义(P<0.05);术后3 d,观察组与对照组患者之间POCD差异无统计学意义(P>0.05)。结论右美托咪定能够有效减少老年冠心病CABG术患者术后应激发应的发生,同时减轻麻醉对患者认知功能的影响,减少认知功能障碍发生的概率,具有较好的临床应用价值。

Objective To investigate the effects of dexmedetomidine on stress response and cognitive function in elderly patients with coronary artery disease undergoing coronary artery bypass grafting(CABG).Methods Ninety-eight elderly patients with coronary heart disease who underwent CABG from December 2016 to January 2019 in Shenzhen People's Hospital were selected as the study subjects.According to random number table method,the patients were divided into the observation group and control group,with 49 cases each groups.After induction of anesthesia and tracheal intubation,the patients in the observation group received 0.4μg/(kg·h)dexmedetomidine continuous infusion,while the patients in the control group received the same dose of saline as a placebo intravenous drip.The levels of stress hormone angiotensinⅡ(AngⅡ)and cortisol at 12 hours after operation were compared between the two groups.Simple Mental State Scale(MMSE)was used to evaluate the cognitive function of the patients.The scores of MMSE and the occurrence of postoperative cognitive dysfunction(POCD)were recorded and compared between the two groups.Results There was no significant difference in preoperative AngⅡlevel and cortisol level between the two groups(P>0.05).The levels of AngⅡand cortisol at 6 hours after operation in the observation group were(40.13±9.29)ng/L and(75.60±12.88)mol/L respectively,which were significantly lower than(57.67±10.18)ng/L and(89.33±15.61)mol/L in the control group(P<0.05).On the 1st day before operation,the MMSE score of the patients in the observation group was(28.38±0.15)versus(28.33±0.16)of the patients of the control group(P>0.05).On the 1st day,3rd day and 7th day after operation,the MMSE scores of the patients in the observation group were 24.31±0.88,26.46±1.01 and 28.20±0.44,respectively,which were significantly higher than corresponding 21.58±1.21,23.75±0.98 and 26.81±0.52 of the control group(all P<0.05).On the 1st and 2nd day after operation,the incidence of POCD in the observation group was 6.12%and 2.04%,which was significantly lower than 20.41%and 16.33%in the control group(P<0.05).Three days after operation,there were no significant difference in the incidence of POCD between the observation group and the control group(P>0.05).Conclusion Dexmedetomidine can effectively reduce the occurrence of post-operative stress response in elderly patients with coronary artery disease after CABG surgery,at the same time reduce the influence of anesthesia on cognitive function of patients,reduce the probability of cognitive dysfunction,which has good clinical application value.