右美托咪定维持麻醉对腰后路减压植骨融合内固定术患者肝肾功能和术后认知功能的影响

Effect of dexmedetomidine maintenance anesthesia on liver and kidney function and postoperative cognitive function in patients undergoing posterior lumbar decompression,bone graft fusion and internal fixation

目的:观察右美托咪定维持麻醉对腰后路减压植骨融合内固定术患者的肝肾功能和术后认知功能的影响。方法:选择收治的134例行腰后路减压植骨融合内固定术患者作为研究对象,使用随机数表法将其分为观察组(67例)和对照组(67例)。观察组在麻醉诱导前10 min内静脉注射右美托咪定0.5~1.0μg/kg,再以0.5~1.0μg/(kg·h)的速度持续注射右美托咪定,手术结束前20~30 min停止;对照组静脉注射观察组等容量生理盐水,手术结束前20~30 min停止。观察并记录:①麻醉前、术后5 min、术后48 h检测血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、尿素(UREA)、血清肌酐(Cr)、胱抑素C(CysC)浓度;②使用简易智力状态检查量表(MMSE)评价麻醉前、治疗术后1、3、7 d患者的认知功能;③记录两组患者术中出血量、手术时间、麻醉时间、术后苏醒时间、住院时间、自控镇痛次数、丙泊酚和舒芬太尼用量及两组患者不良反应发生情况。结果:①与麻醉前相比,术后5 min、术后48 h两组AST、ALT、UREA、Cr、CysC水平均较低,差异有统计学意义(均P<0.05);与对照组相比,术后5 min、术后48 h观察组AST、ALT、UREA、Cr、CysC水平较低,差异有统计学意义(均P<0.05);②术后1 d,两组MMSE评分均有所降低,术后3、7 d,两组MMSE评分呈上升趋势,差异有统计学意义(均P<0.05);术后1、3、7 d观察组MMSE评分较高,差异有统计学意义(均P<0.05);③与对照组相比,观察组自控镇痛次数减少、丙泊酚和舒芬太尼用量减少,且观察组(8.96%)不良反应总发生率较对照组(22.39%)低,差异有统计学意义(P<0.05)。结论:在腰后路减压植骨融合内固定术中使用右美托咪定维持麻醉具有较好的麻醉效果,能够减少丙泊酚、舒芬太尼等药物用量,对患者的认知功能影响小,对肝肾功能具有一定保护作用,安全性较高。

Objective:To observe the effect of dexmedetomidine maintenance anesthesia on liver and kidney function and postoperative cognitive function in patients undergoing posterior lumbar decompression,bone graft fusion and internal fixation.Methods:134 patients who underwent posterior lumbar decompression,bone graft fusion and internal fixation were selected and randomly divided into observation group(67 cases)and control group(67 cases).In the observation group,dexmedetomidine was injected intravenously within 10 minutes before induction of anesthesia at 0.5~1.0μg/kg,and then dexmedetomidine was continuously injected at a rate of 0.5~1.0μg/(kg·h),and stopped 20~30 minutes before the end of the operation.In the control group,equal volume of normal saline was injected intravenously,and stopped 20~30 minutes before the end of the operation.The levels of AST,ALT,UREA,Cr and CysC before anesthesia,5 minutes and 48 hours after operation were measured.The cognitive function of patients before anesthesia and 1,3 and 7 days after operation was evaluated by MMSE.Intraoperative blood loss,operation time,anesthesia time,postoperative wake-up time,hospitalization time,number of patient-controlled analgesia,propofol and sufentanil dosage,and adverse reactions of the two groups were recorded.Results:The levels of AST,ALT,UREA,Cr and CysC 5 minutes and 48 hours after operation in the two groups were lower than those before anesthesia,and the observation group was lower than the control group(all P<0.05).At 1 day after operation,the MMSE scores of the two groups decreased.At 3 and 7 days after operation.The MMSE scores of the two groups showed an upward trend,and the observation group had higher MMSE scores at 1,3,and 7 days after operation(all P<0.05).Compared with the control group,the number of patient-controlled analgesia and the dosage of propofol and sufentanil in the observation group were reduced(all P<0.05).The total incidence of adverse reactions in the observation group was 8.96%,which was lower than 22.39%in the control group(P<0.05).Conclusion:The use of dexmedetomidine to maintain anesthesia in posterior lumbar decompression,bone graft fusion and internal fixation can have better anesthetic effect,and can reduce the dosage of propofol,sufentanil and other drugs,and has little impact on the cognitive function of patients,and has a certain protective effect on liver and kidney function,and has high safety.