右美托咪定联合丙泊酚全身麻醉对颅内动脉瘤栓塞术老年患者术后早期认知功能的影响

Effect of Dexmedetomidine Combined with Propofol on Early Cognitive Function in Elderly Patients Undergoing Interventional Embolization of Intracranial Aneurysm

目的:探讨右美托咪定联合丙泊酚全身麻醉对颅内动脉瘤栓塞术中老年患者血流动力学及术后苏醒、早期认知功能的影响。方法:选择2020年1-7月在本院行全身麻醉下颅内动脉瘤栓塞术的老年患者60例。将患者随机分为右美托咪定组(D组)和对照组(C组),每组30例。D组术前微量注射泵泵入右美托咪定0.8μg/kg;C组术前微量注射泵泵入0.9%氯化钠溶液。记录两组麻醉诱导前(T_(0))、手术开始时(T_(1))、手术进行10 min时(T_(2))、手术结束时(T_(3))、苏醒时(T_(4))的血压(BP)、心率(HR)及脉搏氧饱和度(SpO_(2)),记录两组麻醉时间、丙泊酚用量、苏醒时间、定向力恢复时间及术后谵妄、低血压、心动过缓、呼吸抑制、体动、寒战等不良反应发生情况。采用简易精神状态检查量表(MMSE)评定两组患者手术前后的认知功能。结果:D组T_(1)~T_(3)的SBP均高于C组,差异均有统计学意义(P<0.05);两组T0、T_(4)时的SBP比较,差异均无统计学意义(P>0.05)。D组T_(1)~T_(4)的HR均低于C组,差异均有统计学意义(P<0.05);两组T0~T_(4)的DBP、SpO_(2)比较,差异均无统计学意义(P>0.05)。D组术后谵妄发生率显著低于C组,差异有统计学意义(P<0.05);两组低血压、心动过缓、呼吸抑制、体动、寒战发生率比较,差异均无统计学意义(P>0.05)。术前1 d,两组MMSE评分比较,差异无统计学意义(P>0.05);手术结束后1 h和术后1、2 d,D组MMSE评分均高于C组,差异均有统计学意义(P<0.05)。结论:颅内动脉瘤栓塞术中,右美托咪定联合丙泊酚全身麻醉能有效维持老年患者的血流动力学稳定,能够改善老年患者术后早期的认知功能。

Objective:To investigate the effects of Dexmedetomidine combined with Propofol general anesthesia on hemodynamics,postoperative recovery and early cognitive function in middle-aged and elderly patients undergoing intracranial aneurysm embolization.Method:A total of 60 elderly patients who underwent intracranial aneurysm embolization under general anesthesia in our hospital from January to July in 2020 were selected.The patients were randomly divided into Dexmedetomidine group(group D)and control group(group C),30 cases in each group.Group D was injected with Dexmedetomidine 0.8μg/kg by microinjection pump before surgery,group C was injected with 0.9% Sodium Chloride Solution by micro injection pump before surgery.Blood pressure(BP),heart rate(HR)and pulse oxygen saturation(SpO_(2))were recorded before anesthesia induction(T_(0)),at the beginning of surgery(T_(1)),10 min after surgery(T_(2)),at the end of surgery(T3),at recovery(T_(4)).Anesthesia time,dosage of Propofol,recovery time,recovery time of orientation and postoperative adverse reactions such as delirium,hypotension,bradycardia,respiratory depression,body movement and shivering were recorded.The simple mental state examination scale(MMSE)was used to assess the cognitive function before and after surgery between the two groups.Result:The SBP of T_(1) to T3 in group D were higher than those in group C,the differences were statistically significant(P<0.05).Comparison of SBP between the two groups at T0 and T_(4),there were no significant differences(P>0.05).HR from T_(1) to T_(4) in group D were lower than those in group C,the differences were statistically significant(P<0.05).Comparison of DBP and SpO_(2) of T0 to T_(4) between the two groups,there were no significant differences(P>0.05).The incidence of postoperative delirium in group D was significantly lower than that in group C,the difference was statistically significant(P<0.05).Comparison of the incidences of hypotension,bradycardia,respiratory depression,body motion and chills between the two groups,there were no significant differences(P>0.05).1 d before surgery,comparison of MMSE scores between the two groups,there was no significant difference(P>0.05).1 h,1 d,2 d after surgery,the MMSE scores of group D were higher than those of group C,the differences were statistically significant(P<0.05).Conclusion:During intracranial aneurysm embolization,Dexmedetomidine combined with Propofol general anesthesia can effectively maintain the hemodynamic stability of elderly patients and improve the cognitive function of elderly patients in the early stage after operation.