右美托咪定对老年患者全麻肝叶切除术术后认知功能障碍的影响

Effect of dexmedetomidine on cognitive dysfunction in elderly patients receiving hepatectomy surgery in general anesthesia

目的探讨右美托咪定对老年患者全麻肝叶切除术术后认知功能障碍的影响。方法选择我院2018年8月~2019年8月择期全麻肝叶切除术的老年患者120例,年龄65~80岁,ASAⅡ~Ⅲ,随机分为右美托咪定组(DH组)和生理盐水组(HS组)。DH组在全麻诱导开始15 min内静脉泵入0.6μg/kg右美托咪定,术中以0.2~0.5μg/(kg·h)维持泵注;HS组静脉泵注等量的生理盐水。采用简易精神状态量表记录患者术前及术后第1、2天的MMSE评分,同时检测患者血浆IL-1、IL-6、TNF-α水平。结果与术前比较,术后第1、2天的MMSE评分明显降低(P<0.05)。与HS组比较,DH组术后第1、2天的MMSE评分明显升高(P<0.01),血清IL-1、IL-6、TNF-α水平明显降低(P<0.05)。结论右美托咪定对老年肝叶切除术患者术后认知功能有一定的保护作用,可能与降低患者血浆IL-1、IL-6、TNF-α水平有关。

Objective To investigate the effects of dexmedemidine on cognitive dysfunction in elderly patients receiving hepatectomy surgery in general anesthesia.Methods 120 elderly patients(2018.08-2019.08 in our hospital.aged 65-80 years old,ASAⅡ-Ⅲgrade)undergoing hepatectomy operation were randomly divided into two groups with 60 each:Dexmedemidine group(DH)and saline control group(HS).In group DH,dexmedemidine was infused over 10 min with loading dose 0.6μg/kg and then 0.2-0.5μg/(kg·h)as a maintenance dose.Group HS patients received the same volume of saline.Mini mental state examination(MMSE)was used for evaluation of cognitive dysfunction 1 day before operation,1 day and 2 days postoperatively.Serum inflammatory factors associated the expression level of TNF-α,IL-1 and IL-6 was detected.Results Compared with the preoperative baseline,MMSE score decreased after 1 day and 2 days after surgery.However,MMSE score 1 day and 2 days after surgery in group HS were significantly lower than those in group DH.Compared with the HS group,patients serum TNF-α,IL-1 and IL-6 levels were significantly higher in DH group(P<0.05).Conclusion Dexmedemidine can reduce the incidence of the cognitive dysfunction in elderly patients receiving hepatectomy surgery,the mechanism may be related to decrease the expression of inflammatory factors TNF-α,IL-1 and IL-6.