不同剂量右美托咪定对老年患者腹腔镜胆囊切除术后认知功能障碍发生的影响

Effects of Different Doses of Dexmedetomidine on Elderly Patients’Postoperative Cognitive Dysfunction After Laparoscopic Cholecystectomy

目的探讨不同剂量右美托咪定(DEX)对老年患者腹腔镜胆囊切除术后认知功能障碍(POCD)发生的影响。方法选取重庆市第五人民医院2016年1月至2019年1月收治拟行腹腔镜胆囊切除术的老年患者93例,随机分为低、中、高剂量组,各31例,术中分别予0.2,0.5,0.8μg/(kg·h)的盐酸右美托咪定注射液静脉注射。结果3组患者手术时间、失血量、尿量无显著差异(P>0.05);与使用DEX前(T_0)比较,低剂量组插管后即刻(T_(1))、切皮时(T_(2))及中、高剂量组患者T_(1)、T_(2),手术30 min(T_(3))、拔管后(T_(4))的平均动脉压(MAP)显著降低;与T_0比较,低剂量组T_(1)及中、高剂量组患者T_(1),T_(2),T_(3),T_(4)的心率显著减缓(P<0.05);3组患者在各时间点的血氧饱和度无显著差异(P>0.05);与低剂量组比较,高剂量组患者的自主呼吸时间、苏醒时间、拔管时间均显著延长(P<0.05);与术前1 d比较,低剂量组患者术后1 d的简易精神状况量表评分显著降低(P<0.05);低剂量组有9例发生POCD,显著多于中、高剂量组的3例和2例(P<0.05)。结论在0.5μg/(kg·h)剂量下,DEX可有效缓解老年患者腹腔镜下胆囊切除术后的POCD。

Objective To investigate the effects of different doses of dexmedetomidine(DEX)on postoperative cognitive dysfunction(POCD)in elderly patients after laparoscopic cholecystectomy.Methods A total of 93 elderly patients before undergoing laparoscopic cholecystectomy in the Fifth People’s Hospital of Chongqing from January 2016 to January 2019 were selected and randomly divided into low-dose group,medium-dose group and high-dose group,31 cases in each group.The patients in the three groups were injected with 0.2,0.5,0.8μg/(kg·h)of Dextrometramidine Hydrochloride Injection by intravenous injection.Results There was no significant difference in operation time,blood loss,and urine output among the three groups(P>0.05).Compared with that before using dexmedetomidine(T0),the mean arterial pressure(MAP)at the time points of immediately after intubation(T_(1)),at skin incision(T_(2))in the low-dose group and that at the time points of T_(1),T_(2),30 min after the operation(T_(3))and after trachea extubation(T_(4))in the medium-dose group and high-dose group was significantly decreased.Compared with that at T0,the heart rate at T_(1) in the low-dose group and that at T_(1),T_(2),T_(3) and T_(4) in the medium-dose group and high-dose group were significantly decreased(P<0.05).There was no significant difference in oxygen saturation among the three groups at each time point(P>0.05).Compared with those in the low-dose group,the spontaneous breathing time,awakening time and extubation time in the high-dose group were significantly longer(P<0.05).Compared with those on the day before operation,the Mini-Mental State Scale(MMSS)score in the low-dose group was significantly lower on the first day after operation(P<0.05).One day after operation,there were nine cases of POCD in low-dose group,which were significantly more than three cases and two cases in the medium-dose group and high-dose group(P<0.05).Conclusion 0.5μg/(kg·h)of dexmedetomidine can effectively relieve POCD after laparoscopic cholecystectomy in elderly patients.