瑞芬太尼联合右美托咪定对全麻下髋关节置换术患者脑氧代谢和认知功能的影响

Effects of remifentanil combined with dexmedetomidine on cerebral oxygen metabolism and cognitive function in patients undergoing hip arthroplasty under general anesthesia

目的 探讨髋关节置换术采用瑞芬太尼联合右美托咪定全麻对认知功能和脑氧代谢的影响。方法 选取2018年1月至2021年1月驻马店市第一人民医院收治行全麻髋关节置换术62例患者,根据麻醉方式不同,将瑞芬太尼麻醉的31例作为对照组,将瑞芬太尼联合右美托咪定麻醉的31例作为观察组。比较两组脑氧代谢、血流动力与认知功能变化。结果 两组T_(1)、T_(2)、T_(3)与术后4 h(T_(4))的颈内静脉血氧含量(CjvO_(2))与动脉血氧含量(CaO_(2))均呈现逐渐降低趋势,且观察组低于对照组,差异有统计学意义(P<0.05);两组术后1 d、术后3 d与术后7 d的血清S100β蛋白水平与MMSE评分均低于术前,观察组术后1 d、术后3 d的血清S100β蛋白水平与MMSE评分高于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论 瑞芬太尼联合右美托咪定可促使全麻下髋关节置换术患者血流动力学保持稳定,维持脑氧代谢,并减轻对认知功能产生的影响。

Objective To investigate the effects of remifentanil combined with dexmedetomidine on cerebral oxygen metabolism and cognitive function in patients undergoing hip replacement under general anesthesia.Methods A total of 62 patients with hip replacement under general anesthesia admitted to our hospital from January 2018 to January 2021 were selected as the research objects.According to different anesthesia methods,they were the group observation and the divided into group control,in each group with 31 cases.The group control was anesthetized with remifentanil,while the observation group was anesthetized with remifentanil combined with dexmedetomidine.The changes of cerebral oxygen metabolism,hemodynamic and cognitive function were compared between the two groups.Results The internal carotid venous oxygen content(CjvO_(2)) and arterial oxygen content(CaO_(2)) of the two groups at T_(1),T_(2),T_(3) and 4 hours after operation(T_(4)) showed a gradually decreasing trend,the group control was lower than the group observation the difference was statisically significant,(P<0.05).The serum S100β protein level and MMSE score at 1 day,3 days and 7 days after operation in the two groups were lower than that of before operation.The serum S100β protein level and MMSE score at 1 day and 3 days after operation of the observation group were higher than that of the group control than(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Remifentanil combined with dexmedetomidine can promote hemodynamic stability,maintain cerebral oxygen metabolism,and reduce the impact on cognitive function in patients undergoing hip replacement under general anesthesia.