右美托咪定对全身麻醉老年患者术后的临床效果及对早期认知功能的影响

Clinical Effect of Dexmedetomidine in Elderly Patients under General Anesthesia after Surgery and Its Influence of Early Cognitive Function

目的:探索右美托咪定在全身麻醉的老年患者术中的效果及对患者术后早期认知功能的影响。方法:选取本院2019年2月-2020年6月收诊的130例手术治疗老年患者为研究对象,按照随机数字表法分为对照组和观察组,各65例。对照组给予气管插管全身麻醉,观察组在对照组基础上应用右美托咪定,对比两组术后认知功能障碍发生率、MMSE评分及麻醉诱导前15 min(t0)、输注右美托咪定或生理盐水负荷剂量完成时(t1)、气管插管即刻(t2)、切皮时(t3)、手术结束时(t4)、拔管即刻(t5)的血流动力学指标。结果:观察组t1时的HR低于对照组(P<0.05);对照组t2、t5时的HR均高于观察组(P<0.05);两组t2、t3时MAP较t0时明显提高,观察组低于对照组(P<0.05);对照组t5时MAP高于观察组(P<0.05)。观察组术后1、7 d的MMSE评分均高于对照组(P<0.05);术后1、7 d的认知功能障碍发生率低于对照组(P<0.05)。两组术后自主呼吸恢复时间比较差异无统计学意义(P>0.05),观察组苏醒时间早于对照组(P<0.05)。结论:右美托咪定在老年手术患者全麻中应用能有效维持术中血流动力学稳定,促进术后尽早苏醒,预防认知功能障碍发生,值得推广。

Objective:To explore the effect of Dexmedetomidine in elderly patients undergoing general anesthesia during surgery and its influence on early postoperative cognitive function.Method:A total of 130 elderly patients underwent surgical treatment in our hospital from February 2019 to June 2020 were selected as the research objects,and they were divided into the control group and the observation group according to a random number table,with 65 cases in each group.The control group was given general anesthesia for tracheal intubation,and the observation group was given Dexmedetomidine on the basis of the control group.The incidence of postoperative cognitive dysfunction,MMSE score,15 min before induction of anesthesia(t0),at the time of Dexmedetomidine or normal saline load dose completed(t1),at the time of endotracheal intubation(t2),skin cutting(t3),at the end of the operation(t4),at the time of after extubation(t5)of hemodynamic indicators were compared between the two groups.Result:The HR of the observation group at t1 was lower than that of the control group(P<0.05);the HR of the control group at t2 and t5 were higher than those of the observation group(P<0.05);the MAP of the two groups at t2 and t3 increased significantly than that at t0,the observation group was lower than the control group(P<0.05);the MAP at t5 of the control group was higher than that of the observation group(P<0.05).The MMSE score of the observation group were higher than that of the control group on the 1st and 7th day after operation(P<0.05),and the incidence of postoperative cognitive dysfunction on the 1st and 7th day after operation of the observation group was lower than that of the control group(P<0.05).There was no significant difference in the recovery time of spontaneous breathing after operation(P>0.05),the recovery time of the observation group was earlier than that of the control group(P<0.05).Conclusion:The application of Dexmedetomidine in general anesthesia in elderly patients with surgery can effectively maintain intraoperative hemodynamic stability,promote early postoperative recovery,and prevent cognitive dysfunction.It is worthy of promotion.