右美托咪定在降低老年腰椎手术患者术后认知功能障碍发生率中的应用

Application of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction in elderly patients undergoing lumbar surgery

目的:探讨右美托咪定在降低老年腰椎手术患者术后认知功能障碍发生率中的应用。方法:选取114例老年腰椎手术患者,随机分为对照组(给予生理盐水)、观察A组(给予右美托咪定0.50μg/kg)和观察B组(给予右美托咪定1.0μg/kg),每组38例。比较三组患者手术时间、术中出血量、围手术期镇痛药物使用量、术中窦性心动过缓、术中血压异常及术后认知功能障碍的发生情况。结果:三组患者手术时间和术中出血量比较,均无统计学差异(P>0.05)。与对照组比较,观察A组和观察B组患者围手术期丙泊酚、芬太尼、瑞芬太尼用量均明显减少(P<0.05)。与观察A组比较,观察B组患者围手术期丙泊酚、芬太尼、瑞芬太尼用量均明显减少(P<0.05)。与对照组比较,观察A组与观察B组患者术中窦性心动过缓发生率均显著升高(P<0.05)。观察A组患者术中高血压发生率明显高于对照组和观察B组(P<0.05)。与观察B组比较,对照组和观察A组患者术后认知功能障碍发生率均明显升高(P<0.05)。结论:1.0μg/kg剂量的右美托咪定在老年腰椎手术患者全麻镇痛过程中具有减少围手术期阿片类药物和镇静药物用量及降低术后认知功能障碍发生率等多种作用,具有良好的临床应用优势。

Objective:To analyze the application of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction in elderly patients undergoing lumbar surgery.Methods:114 elderly patients underwent lumbar surgery were randomly divided into control group(given normal saline),observation group A(given 0.50μg/kg dexmedetomidine)and observation group B(given 1.0μg/kg dexmedetomidine),with 38 cases in each group.The operation time,intraoperative hemorrhage,perioperative analgesic use,intraoperative sinus bradycardia,intraoperative blood pressure abnormality and postoperative cognitive dysfunction were compared between the three groups.Results:There was no significant difference in operation time and bleeding volume between the three groups(P>0.05).Compared with the control group,the perioperative use of propofol,fentanyl and remifentanil in observation group A and observation group B were significantly reduced(P<0.05).Compared with observation group A,the perioperative use of propofol,fentanyl and remifentanil in observation group B was significantly reduced(P<0.05).Compared with the control group,the incidence of sinus bradycardia in observation group A and observation group B were increased significantly(P<0.05).The incidence of intraoperative hypertension in observation group A was significantly higher than that in control group and observation group B(P<0.05).Compared with observation group B,the incidence of postoperative cognitive dysfunction in control group and observation group A were significantly increased(P<0.05).Conclusion:Dexmedetomidine at a dose of 1.0μg/kg can reduce the use of opioids and sedatives in perioperative period,and reduce the incidence of postoperative cognitive dysfunction in the elderly patients undergoing lumbar surgery.