右美托咪定对老年肝癌病人术后炎症及认知功能的影响

Effect of dexmedetomidine on the postoperative cognitive function and inflammatory cytokines in elderly patients with cirrhosis

目的:观察右美托咪定(Dex)对老年肝癌病人术后炎症细胞因子和早期认知功能的影响。方法:选取择期进行肝癌切除术的老年肝硬化病人52例,Child-Pugh肝功能分级为A级,ASAⅡ~Ⅲ级,随机分为对照组(Con组)和右美托咪定组(Dex组),各26例。Con组采用常规全身麻醉,Dex组在常规全身麻醉基础上于麻醉诱导前泵注Dex(0.5μg/kg)10 min,并以0.4μg·kg-1·h-1持续泵注至关腹。检测2组病人术前1 d与术后即刻、术后24 h、术后48 h血S-100β蛋白、炎症细胞因子等指标,并采用简易精神状态评价量表(MMSE)评估病人认知功能。结果:2组外周血S-100β蛋白、白细胞介素-6、肿瘤坏死因子α水平在术后不同时间点均较术前不同程度的升高(P<0.05~P<0.01);Dex组S-100β蛋白、IL-6、TNF-α水平在术后即刻、术后24 h和术后48 h均明显低于对照组(P<0.05~P<0.01)。Dex组术后认知功能障碍发生率明显低于Con组(P<0.05)。结论:Dex能降低老年肝癌病人术后认知功能障碍的发生率,其机制可能与减轻炎症反应有关。

Objective:To investigate the effects of dexmedetomidine(Dex)on the postoperative cognitive function and plasma inflammatory cytokines in elderly patients with cirrhosis.Methods:Fifty-two type ASAⅡ-Ⅲelderly patients with cirrhosis scheduled by liver resection were divided into the control group and Dex group(26 cases in each group).In the control group,the routine general anesthesia was used,while in the DEX group,on the basis of routine general anesthesia,the Dex(0.5 g/kg)was pumped for 10 min before anesthesia induction,and 0.4μg·kg-1·h-1 infusion until the peritoneum was suture.The serum levels of S-100βprotein,inflammatory cytokines and other indexes in two groups were detected before 1 day of surgery,immediately after surgery,and after 24 h and 48 h of surgery,and the cognitive function of patients was evaluated using MMSE.Results:The serum levels of S-100βprotein,IL-6 and TNF-αin two groups after operation significantly increased compared with before operation(P<0.05 to P<0.01).The serum levels of S-100βprotein,IL-6 and TNF-αin Dex group at the end of operation,24 h and 48 h after operation were significantly lower than those in control group(P<0.05 to P<0.01).The incidence rate of postoperative cognitive dysfunction(POCD)in Dex group was significantly lower than that in control group(P<0.05).Conclusions:Dex can decrease the incidence rate of POCD in the elderly cirrhosis patients treated with liver resection,which might be mediated by the inhibition of perioperative inflammatory response.