右美托咪定联合舒芬太尼术后镇痛对老年患者术后认知功能和血清S100β蛋白的影响

Effect of dexmedetomidine combined with sufentanil postoperative analgesia on the cognitive function and S 100β protein of elderly patients

目的:探讨右美托咪定(Dexmedetomidine,DEX)联合舒芬太尼术后镇痛对老年患者术后认知功能和S100β蛋白的影响。方法:选取择期行腹腔镜直肠癌或乙状结肠癌根治术的老年患者90例,随机分为A、B、C三组,各30例。A组(对照组):舒芬太尼1.5μg·kg^(-1)+生理盐水至100 mL;B组:舒芬太尼1.5μg·kg^(-1)+DEX 1μg·kg^(-1)+生理盐水至100 mL;C组:舒芬太尼1.5μg·kg^(-1)+DEX 2μg·kg^(-1)+生理盐水至100 mL。观测各时点血清S100β蛋白水平、简易精神状态(MMSE)评分、视觉模拟疼痛(VAS)评分、镇静Ramsay评分及不良反应。结果:与术后6 h比较,三组患者在术后12 h、术后24 h、术后48 h VAS、Ramsay评分均降低(P<0.05),与A组比较,B、C两组术后12 h、术后24 h、术后48 h VAS评分降低(P<0.05);与术前比较,A组术后1 d、3 d、5 d、7 d,B组术后1 d、3 d、5 d,C组术后1 d、3 d的MMSE评分降低、S100β蛋白升高;与A组比较,B组、C组术后的MMSE评分增加、S100β蛋白降低,且三组MMSE评分与S100β蛋白呈负相关(r=−0.686、−0.652、−0.661,P<0.001);C组不良反应发生率低于A组(P<0.05)。结论:DEX辅助舒芬太尼用于老年患者术后静脉镇痛,具有镇痛、镇静效果好,不良反应少等优点。

Objective:To study the effects of dexmedetomidine(DEX)combined with sufentanil postoperative analgesia on the cognitive function and S100βprotein of elderly patients.Methods:A total of 90 elderly patients with rectal cancer or colorectal cancer undergoing laparoscopic radical operation were randomly divided into Group A(control group,30 cases):sufentanil 1.5μg·kg^(-1)+normal saline to 100 mL;Group B(30 cases):sufentanil 1.5μg·kg^(-1)+dexmedetomidine(DEX)1μg·kg^(-1)+normal saline to 100 mL;Group C(30 cases):sufentanil 1.5μg·kg^(-1)+DEX 2μg·kg^(-1)+normal saline to 100 mL.The serum S100βprotein level,mini-mental state examination(MMSE)score,visual analog pain(VAS)score,sedation ramsay score and postoperative adverse reactions were compared among the three groups.Re⁃sults:Compared with 6 h after operation,the VAS and Ramsay scores of the three groups decreased at 12 h,24 h and 48 h(P<0.05).Compared with group A,the VAS scores of group B and C decreased at 12 h,24 h and 48 h(P<0.05).Compared with preoperative,group A had 1 d,3 d,5 d,7 d,group B 1 d,3 d,5 d,group C 1 d,3 d MMSE score decreased,and S100βprotein increased;Compared with Group A,the MMSE scores of Group B and group C after operation were significantly increased,the concentration of S100βprotein were decreased,and the MMSE score and the S100βprotein lever were negatively correlated in the three groups(r=−0.686,−0.652,−0.661,respectively,P<0.001);The incidence of adverse reactions in Group C was lower than that in Group A(P<0.05).Conclusion:DEX combined with sufentanil for postoperative intravenous analgesia in elderly patients has the advantages of analgesia,good sedative effect and less side effects.