右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响

The Impacts of Dexmedetomidine on Cerebral Oxygen Saturation and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Hepatedctomy

目的:探讨右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响。方法:选取拟行腹腔镜肝切除术的老年患者100例,将患者随机分为试验组和空白组,每组50例。试验组静脉泵注右美托咪定0.2ug·kg^(-1)·h^(-1),维持至手术结束前30min。空白组以同样方式泵注等量0.9%生理盐水。记录患者入室(T_(0))、切皮(T_(1))、开始切肝(T_(2))、切肝完成(T_(3))、术毕(T_(4))的MAP、HR。持续监测局部脑氧饱和度(regional cerebral oxygen saturation,rSO_(2)),计算术中rSO2平均值(rSO_(2))、术中rSO_(2)最小值(rSO_(2min))、rSO_(2)较基础值下降的最大百分比(rSO_(2%max))。分别于术前1d、术后第1、3、7天进行MMSE评分,记录两组患者术后认知功能障碍(postoperative cognitive disfunction,POCD)的发生情况及住院时间。记录两组患者清醒时间、拔管时间及恢复期不良反应发生率。结果:试验组在T_(2)、T_(3)的MAP明显高于空白组,HR明显低于空白组,比较差异有统计学意义(P<0.05)。在T_(2)~T_(4)时间点,试验组rSO_(2%max)明显低于空白组,比较差异有统计学意义(P<0.05);两组患者rSO_(2min)和rSO_(2)比较差异无统计学意义(P>0.05)。试验组POCD发生率明显少于空白组,比较差异有统计学意义(P<0.05)。试验组住院时间较空白组明显减少,比较差异有统计学意义(P<0.05)。两组患者清醒时间、拔管时间比较差异无统计学意义(P>0.05)。试验组麻醉恢复期不良反应发生率均显著低于空白组(P<0.05)。结论:右美托咪定能维持患者循环系统的稳定,使脑氧处于供需平衡状态,不影响恢复质量,术后并发症少,对术后认知功能无影响,降低POCD发生率。

Objective:To investigate the impacts of dexmedetomidine on cerebral oxygen saturation and postoperative cognition in elderly patients undergoing laparoscopic hepatectomy.Methods:One hundred elderly patients who were to undergo laparoscopic hepatectomy were selected,and the patients were randomly divided into experimental group and blank group using the random number table method,with 50 cases in each group.In the experimental group,dexmedetomidine 0.2ug·kg^(-1)·h^(-1) was pumped intravenously and maintained until 30 min before the end of the operation,and in the blank group,the same amount of 0.9%saline was pumped in the same way.The MAP and HR were recorded at room entry(T_(0)),skin incision(T_(1)),start of liver incision(T_(2)),completion of liver incision(T_(3)),and end of surgery(T_(4)).Regional cerebral oxygen saturation(rSO_(2))was monitored continuously and the mean intraoperative rSO_(2)(rSO_(2)),the minimum intraoperative rSO_(2) value(rSO_(2min)),and the maximum percentage decrease of rSO_(2) from the basal value(rSO_(2%max))were calculated.The MMSE scoring were performed at 1 d before surgery,1,3 and 7 d after surgery,and the occurrence of postoperative cognition disorders(POCD)and the number of days of hospitalization were recorded in the two groups,respectively.The time of awakening,time of extubation and the incidence of adverse reactions during the recovery period were recorded.Results:The MAP of the experimental group was significantly greater than that of the blank group at T_(2) and T_(3),and the HR was significantly lower than that of the blank group,and the difference was statistically significant(P<0.05).At the time points from T_(2) to T_(4),the rSO_(2%max) of the experimental group was significantly lower than that of the blank group,and the difference was statistically significant(P<0.05);there was no statistically significant difference in the rSO_(2min) and rSO_(2) comparison between the 2 groups of patients(P>0.05).The incidence of POCD in the experimental group was significantly less than that in the blank group,and the difference was statistically significant(P<0.05).The hospitalization time of the experimental group was significantly shorter than that of the blank group and the difference was statistically significant(P<0.05).There was no statistic significance in revival time and the time for withdrawing the catheter between the 2 groups(P>0.05).The incidence of adverse reactions during the awakening period was significantly lower in the experimental group than in the blank group(P<0.05).Conclusion:Dexmedetomidine can maintain the stability of the patient's circulatory system,keep brain oxygen in a balanced state of supply and demand without affecting the recovery quality.It has few postoperative complications,has no effect on postoperative cognitive function,and it reduces the incidence of POCD.