不同剂量右美托咪定对老年结肠癌患者术后认知功能的影响

Effects of different doses of dexmedetomidine on postoperative cognitive function in elderly colon cancer patients

目的探讨术中静脉注射不同剂量右美托咪定对老年结肠癌患者全身麻醉术后认知功能的影响。方法选取辽宁省本溪市中心医院行择期手术的65~80岁老年结肠癌患者80例, 美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级, 采用随机数字表法分为试验组和对照组, 试验组根据右美托咪定剂量再分为DD、DM、DX组。各组麻醉前10 min静脉注射右美托咪定0.5 μg/kg, 麻醉后DD组以0.7 μg·kg-1·h-1持续泵入, DM组以0.5 μg·kg-1·h-1持续泵入, DX组以0.2 μg·kg-1·h-1持续泵入, 且手术结束前30 min均停药。NS组同等条件下注射等量的0.9% NaCl溶液。分别于术前1天及术后30 min、3 h、6 h、12 h、24 h测定各组血清S100β蛋白表达和神经元特异性烯醇化酶(NSE)水平;分别于术前1天和术后第1、3、7天对各组进行简易智能量表(MMSE)评分;比较各组术后认知功能变化及不良反应发生情况。结果 80例患者筛选后有72例符合入组标准(DD组19例, DM组17例, DX组18例, 对照组18例)。四组间术前血清S100β蛋白和NSE水平差异均无统计学意义(均P>0.05), 四组间术后不同时间点S100β蛋白和NSE水平差异均有统计学意义(均P<0.05)。各组S100β蛋白和NSE水平在术后不同时间点较术前均升高, 差异均有统计学意义(均P<0.05)。术后第1天, 四组MMSE评分差异有统计学意义(P<0.05);术后第3天, 对照组与DD组、DX组比较, 差异均有统计学意义(P<0.05);术后第7天, 对照组与DX组比较, 差异有统计学意义(P<0.05)。DD组2例、DM组1例、DX组2例、对照组8例患者出现认知功能下降或围术期神经认知障碍(PND), DD组、DM组、DX组认知功能改变发生率均低于对照组(P<0.05)。DD组9例、DM组7例、DX组4例、对照组3例患者发生不良反应, 各组间不良反应发生率差异无统计学意义(P>0.05)。结论应用右美托咪定可减缓老年结肠癌患者全身麻醉术后认知功能的下降, 降低PND发生率, 且其对患者术后认知功能的改善无剂量依赖性。

Objective To investigate effects of different doses of dexmedetomidine on postoperative cognitive function in elderly colon cancer patients undergoing the general anesthesia.Methods A total of 80 elderly colorectal cancer patients aged 65 to 80 years old who received the surgery with the American Society of Anesthesiologists(ASA)gradeⅡ-Ⅲin Benxi Central Hospital of Liaoning Province were selected.According to the random number table,all patients were divided into 4 groups:the experiment group(group DD,group DM,group DX grouped by the dose of dexmedetomidine)and the control group.All groups were intravenously injected with 0.5μg/kg loading dose dexmedetomidine in 10 minutes before induction of anesthesia;after induction of anesthesia,group DD was continuously pumped into 0.7μg·kg-1·h-1,group DM was continuously pumped into 0.5μg·kg-1·h-1,group DX was continuously pumped into 0.2μg·kg-1·h-1,and all patients had drug withdrawal in 30 min before the end of the surgery.Under the same condition,group NS was injected with the same volume of 0.9%saline.The levels of serum S-100βprotein and neuron specific enolase(NSE)of all groups were measured at the day before operation and 30 min,3 h,6 h,12 h,24 h after operation;Mini-mental state examination(MMSE)score was performed in all groups at the day before operation and 1 d,3 d,7 d after operation.The change of postoperative cognitive function and adverse reactions of all groups were also compared.Results After screening,72 out of 80 patients met the criteria(19 patients in group DD,17 patients in group DM,18 patients in group DX and 18 patients in the control group).There were no statistically significant differences in levels of serum S100βprotein and NSE among 4 groups before operation(all P>0.05),while there were statistically significant differences in levels of S100βprotein and NSE at different time points after operation among all groups(all P<0.05).The levels of S100βprotein and NSE after operation in all groups at different time points were higher than those before operation(all P<0.05).On the 1st day after operation,MMSE scores of 4 groups were significantly different(P<0.05);3 d after operation,the difference in MMSE score was statistically significant when the control group was compared with group DD and group DX(all P<0.05);7 d after operation,the difference was statistically significant between the control group and group DX(P<0.05).Cognitive function decline or perioperative neurocognitive disorders(PND)occurred in 2 cases in group DD,1 case in group DM,2 cases in group DX,8 cases in the control group.The rate of cognitive function changes in group DD,group DM and group DX was lower than that in the control group(P<0.05).Adverse reactions occurred in 9 patients in group DD,7 patients in group DM,4 patients in group DX,and 3 patients in the control group,and there was no significant difference in the incidence of adverse reactions among all groups(P>0.05).Conclusions Dexmedetomidine can slow the decline in postoperative cognitive function after general anesthesia and reduce the incidence of PND for elderly patients with colorectal cancer.Furthermore,dexmedetomidine’s improvement on postoperative cognitive function has no dose-dependence.