不同剂量右美托咪定麻醉诱导对老年单侧髋关节置换术后患者认知功能的影响

Effects of anesthesia induction with different doses of Dexmedetomidine on cognitive function of elderly patients undergoing unilateral hip replacement

目的:观察不同剂量右美托咪定麻醉诱导对老年单侧髋关节置换术后患者认知功能的影响。方法:选取112例行单侧髋关节置换术的老年患者作为研究对象,按照随机数字表法分为对照组和观察组各56例。在常规麻醉措施基础上,对照组予以0.5μg/kg右美托咪定麻醉诱导,观察组予以1.0μg/kg右美托咪定麻醉诱导,比较两组手术前后脑氧代谢指标[颈内静脉血氧饱和度(SjvO2)、颈内静脉血氧含量(CjvO2)、脑氧摄取率(CERO2)]水平、认知功能[蒙特利尔认知评估量表(MoCA)]评分、术后恢复时间和不良反应发生率。结果:术后即刻,观察组SjvO2水平高于对照组,CERO2水平低于对照组,差异均有统计学意义(P<0.05);两组CjvO2水平比较,差异无统计学意义(P>0.05);术后7 d,观察组MoCA评分高于对照组,差异有统计学意义(P<0.05);两组术后自主呼吸恢复时间、拔管时间和睁眼时间比较,差异均无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:1.0μg/kg右美托咪定麻醉诱导应用于老年单侧髋关节置换术患者,可改善术后脑氧代谢指标水平,提高术后认知功能,其效果优于0.5μg/kg右美托咪定麻醉诱导。

Objective:To observe effects of anesthesia induction with different doses of Dexmedetomidine on cognitive function of elderly patients undergoing unilateral hip replacement.Methods:112 elderly patients undergoing unilateral hip replacement were selected as the research objects,and were divided into control group and observation group according to the random number table method,56 cases in each.On the basis of conventional anesthesia measures,the control group was given 0.5μg/kg Dexmedetomidine anesthesia induction,while the observation group was given 1.0μg/kg Dexmedetomidine anesthesia induction.The cerebral oxygen metabolism index levels[internal jugular venous blood oxygen saturation(SjvO2),internal jugular venous blood oxygen content(CjvO2),cerebral extraction of oxygen(CERO2)],the cognitive function scores[Montreal cognitive assessment(MoCA)],the postoperative recovery time and the incidence of adverse reactions were compared between the two groups before and after the surgery.Results:Immediately after the surgery,the level of SjvO2 in the observation group was higher than that of the control group;the level of CERO2 was lower than that of the control group;the differences were statistically significant(P<0.05).There was no significant difference in the CjvO2 level between the two groups(P>0.05).7 days after the surgery,the MoCA score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the recovery time of spontaneous breathing,extubation time and eye opening time between the two groups after the surgery(P>0.05).Further,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:1.0μg/kg Dexmedetomidine anesthesia induction applied to the elderly patients undergoing unilateral hip replacement can improve the postoperative cerebral oxygen metabolism index levels and improve the postoperative cognitive function scores.Moreover,it is superior to 0.5μg/kg Dexmedetomidine anesthesia induction.