右美托咪定对静脉全麻输尿管钬激光碎石术老年患者术后认知和记忆功能的影响

Effect of dexmedetomidine on postoperative cognitive and memory function in elderly patients undergoing ureteral holmium laser lithotripsy under intravenous general anesthesia

目的观察丙泊酚-瑞芬太尼复合右美托咪定静脉全麻对输尿管钬激光碎石术老年患者术后认知和记忆功能的影响。方法选择择期行上段输尿管钬激光碎石术老年患者116例,随机将患者分为丙泊酚-瑞芬太尼麻醉组(C组)和丙泊酚-瑞芬太尼麻醉复合右美托咪定组(A组),每组58例。麻醉诱导后A组静脉泵注右美托咪定0.4μg/(kg•h),C组静脉泵注等容量生理盐水。观察患者术中丙泊酚和瑞芬太尼用量以及手术时间,记录术后患者自主呼吸恢复时间、苏醒时间以及气管导管拔除时间,观察患者苏醒情况并采用Richmond躁动-镇静评分(RASS)评分。分别于麻醉诱导前10分钟(t_(0))、术后3小时(t_(1))、6小时(t_(2))、9小时(t_(3))、24小时(t_(4))、48小时(t_(5))和72小时(t_(6))对患者进行状态-特质焦虑问卷评分(STAI)、简易智能量表评分(MMSE)、Zung抑郁自评量表评分(SDS)和数字记忆评分并记录。结果A组患者苏醒时间和拔管时间均较C组有所延长(P<0.05),A组患者RASS评分较C组显著降低(P<0.05);两组患者术后3小时MMSE评分较麻醉前降低(P<0.05),术后6小时恢复到麻醉前水平;C组患者术后3小时、6小时SDS评分较麻醉前增加(P<0.05),术后9小时恢复到麻醉前水平。A组患者术后3小时SDS评分较麻醉前增加(P<0.05),术后6小时恢复到麻醉前水平;C组患者术后3小时、6小时STAI评分较麻醉前增加(P<0.05),术后9小时恢复到麻醉前水平;A组患者术后3小时STAI评分较麻醉前增加(P<0.05),术后6小时恢复到麻醉前水平;各组患者在术后3小时和6小时数字记忆能力有所降低(P<0.05),术后9小时恢复到麻醉前水平。结论丙泊酚-瑞芬太尼复合右美托咪定静脉全麻对老年患者术后认知和记忆功能的影响时间短暂且恢复较快,同时可降低术后苏醒躁动的发生率,缩短术后患者焦虑和抑郁时间。

Objective To study the effects of dexmedetomidine combined with propofol remifentanil intravenous general anesthesia on postoperative cognitive and memory function in elderly patients.Methods Totally,116 elderly patients who underwent selective holmium laser lithotripsy of the upper ureter were randomly divided into propofol remifentanil anesthesia group(group C)and propofol remifentanil anesthesia combined with dexmedetomidine group(group A),with 58 patients in each group.After anesthesia induction,group A was infused with 0.4μg/(kg•h)of dexmedetomidine intravenously,and group C was infused with saline of the same volume intravenously.The dosages of propofol and remifentanil during operation,operation time,recovery time of spontaneous respiration,recovery time from anesthesia and tracheal catheter extraction time of the patients after operation and Richmond agitation and sedation scale(RASS)score were reviewed.All patients were scored with state-trait anxiety inventory(STAI),mini-mental state examination(MMSE),Zung self-rating depression scale(SDS)and digital memory scale at 10 min(t_(0))before anesthesia induction,3 h(t_(1)),6 h(t_(2)),9 h(t_(3)),24 h(t_(4)),48 h(t_(5))and 72 h(t_(6))after anesthesia induction.Results The recovery time and extubation time were longer in group A than in group C(P<0.05),and the RASS score of patients in group A was significantly lower than that in group C(P<0.05).The MMSE scores of patients in both groups were decreased at 3 hours after operation compared with those before anesthesia(P<0.05),and returned to the levels before anesthesia at 6 hours after operation.The SDS score of patients in group C was increased at 3 h and 6 h after operation compared with that before anesthesia(P<0.05),and returned to the level before anesthesia at 9 h after operation.The SDS score of patients in group A was increased at 3 h after operation compared with that before anesthesia(P<0.05),and returned to the level before anesthesia at 6 h after operation.The STAI score of patients in group C was increased at 3 h and 6 h after operation compared with that before anesthesia(P<0.05),and returned to the level before anesthesia at 9 h after operation.The STAI score of patients in group A were increased at 3 h after operation compared with that before anesthesia(P<0.05),and returned to the level before anesthesia at 6 h after operation.The number memorizing ability of patients in each group was decreased at 3 h and 6 h after operation(P<0.05),and returned to the level before anesthesia at 9 h after operation.Conclusion Dexmedetomidine combined with propofol remifentanil intravenous general anesthesia on cognitive and memory function of elderly patients after operation has a short effect and patients recover quickly.At the same time,it can reduce the incidence of postoperative restlessness and shorten the time of postoperative anxiety and depression.