右美托咪定对老年腹部手术患者术后早期认知功能的影响

Effect of dexmedetomidine on early cognitive function in elderly patients undergoing abdominal surgery

目的:观察右美托咪定(Dex)对老年腹部手术患者术后早期认知功能的影响。方法:选取2018年9月至2019年9月在广西中医药大学附属国际壮医医院行腹部手术的老年患者90例,随机分为对照组(C组)、0.3μg/kg∙h^-1 Dex组(D1组)和0.6μg/kg∙h^-1 Dex组(D2组),每组30例。3组均采用静吸复合全身麻醉。记录患者进入手术室时(T0)、麻醉诱导前(T1)、气管插管后(T2)、切皮时(T3)、手术完成即刻(T4)的心率(HR)及平均动脉压(MAP),并对3组患者术前1 d和术后1 d、3 d、7 d进行蒙特利尔认知评估量表(MoCA)评分及计算术后认知功能障碍(POCD)发生率,同时记录丙泊酚用量、瑞芬太尼用量、苏醒时间、拔管时间及术中低血压、心动过缓等不良反应的发生情况。结果:D1组、D2组患者T2、T3、T4时点HR、MAP低于T0时点和C组(P<0.05),且术后1 d、3 d MoCA评分高于C组、POCD发生率低于C组(P<0.05);D2组患者T2、T3、T4时点HR、MAP低于D1组(P<0.05);D1组、D2组丙泊酚和瑞芬太尼用量低于C组(P<0.05),D2组丙泊酚和瑞芬太尼用量低于D1组(P<0.05);与C组、D1组比较,D2组术中低血压、心动过缓发生率明显升高(P<0.05)。结论:Dex可以促进老年腹部手术患者术后早期认知功能的恢复,且0.3μg/kg∙h^-1持续泵注的不良反应更少。

Objective:To observe the effect of dexmedetomidine(Dex)on early cognitive function in elderly patients undergoing abdominal surgery.Methods:A total of 90 elderly patients who underwent abdominal surgery in our hospital from Sep.2018 to Sep.2019 were randomly divided into control group(group C),0.3μg/kg∙h^-1Dex group(group D1)and 0.6μg/kg∙h^-1Dex group(group D2),with 30 patients in each group.All the three groups were treated with static and general anesthesia.The heart rate(HR)and mean arterial pressure(MAP)were recorded when patients entered the operating room(T0),before anesthesia induction(T1),after trachea cannula(T2),during skin incision(T3)and immediately after operation(T4).The MoCA score was performed among three groups 1 day before operation and 1 day,3 days and 7 days after operation,and the incidence of POCD was calculated.At the same time,the dosage of propofol,remifentanil,awakening time,extubation time,intraoperative hypotension,bradycardia and other adverse reactions were recorded.Results:The HR and MAP at T2,T3 and T4 in D1 and D2 groups were lower than those at T0 and in C group(P<005),and the MoCA score at 1 day and 3 days after operation was higher than that in group C,and the incidence of POCD was lower than that in group C(P<005).The HR and MAP at T2,T3 and T4 in D2 group were lower than those in D1 group(P<005).The dosage of propofol and remifentanil in group D1 and group D2 was lower than that in group D1(P<005),and the dosage of propofol and remifentanil in group D2 was lower than that in group D1(P<005).Compared with group C and group D1,the incidence of intraoperative hypotension and bradycardia in group D2 was significantly higher than that in group C and group D1(P<0.05).Conclusion:Dex can promote the recovery of early cognitive function in elderly patients undergoing abdominal surgery,and the side effects of continuous infusion of 0.3μg/kg∙h^-1 are less.