右美托咪定预防颈动脉狭窄老年患者术后焦虑机制探讨

Mechanism of dexmedetomidine in preventing postoperative anxiety in elderly patients with carotid stenosis

目的探究右美托咪定(dexmedetomidine,Dex)预防老年患者术后焦虑的相关机制。方法招募行颈动脉支架置入术的颈动脉狭窄老年患者90例为研究对象,所有患者经脑血管造影证实为颈动脉狭窄。将患者随机分为Dex组和对照组,每组45例。分别于输注前(T0)、手术后1 h(T1)、手术后6 h(T2)和术后12 h(T3)时点,通过焦虑自评量表(self-rating anxiety scale,SAS)评估患者的焦虑程度;通过简易智力状态检查(mini-mental state examination,MMSE)量表评估患者的精神状态;通过视觉模拟评分(visual analog scale,VAS)法评估患者的疼痛程度。通过蛋白印迹分析自噬相关蛋白和凋亡蛋白的表达情况。结果对照组SAS评分呈先升高再降低趋势,Dex组SAS评分呈逐渐降低趋势,Dex组SAS评分低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组患者MMSE评分均呈先降低后升高的趋势,Dex组MMSE评分高于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组患者VAS评分均呈先升高后降低的趋势,Dex组VAS评分低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。Dex组LC3B-Ⅱ/LC3B-Ⅰ和Beclin蛋白表达低于对照组,p62蛋白表达高于对照组(P<0.05)。Dex组Bcl-2蛋白表达高于对照组,Bax和caspase-3蛋白表达低于对照组(P<0.05)。结论Dex通过抑制细胞过度自噬减少老年患者术后焦虑并达到足够的镇静效果,且不会引起焦虑。

Objective To explore the mechanism of dexmedetomidine(Dex)in preventing postoperative anxiety in elderly patients with carotid stenosis.Methods A total of 90 elderly patients with carotid stenosis who underwent carotid artery stenting were recruited as the research subjects.All patients were confirmed as having carotid stenosis by cerebral angiography.The patients were randomly divided into Dex group and control group,with 45 patients in each group.The self-rating anxiety scale(SAS)was used to assess the anxiety level of patients before infusion(T0),at 1 h after operation(T1),6 h after operation(T2)and 12 h after operation(T3).The mental state of patients was assessed by the mini-mental state examination(MMSE).The patients'pain was evaluated by visual analog scale(VAS),and the expression of autophagy-related protein and apoptosis protein was analyzed by Western blot.Results The SAS score of the control group increased initially and then decreased,and the SAS score of Dex group showed a decreasing trend;the SAS score of Dex group was lower than that of control group,and there were statistically significant differences in interaction between groups,time points,and time points between groups(P<0.05).The MMSE scores of patients in both groups showed a trend of decreasing initially and then increasing,and the MMSE score of Dex group was higher than that of the control group;There were statistically significant differencess in interaction between groups,time points,and time points between groups(P<0.05).The VAS scores of patients in both groups showed a trend of initial increasing and then decreasing,the VAS score of Dex group was lower than that of the control group,and there were statistically significant differences in interaction between groups,time points,and time points between groups(P<0.05).The expression of LC3B-Ⅱ/LC3B-Ⅰand Beclin protein in Dex group was lower than that in control group,while the expression of p62 protein was higher than that of control group(P<0.05).The Bcl-2 protein expression in Dex group was higher than that in control group,while the expression of Bax and caspase-3 protein was lower than that in control group(P<0.05).Conclusion Dex can reduce postoperative anxiety of elderly patients by inhibiting excessive autophagy of cells and achieve enough sedation effect without causing anxiety.