右美托咪定对脊柱手术患者围术期认知功能的影响

Effects of dexmedetomidine on perioperative cognitive function in patients undergoing spine surgery

目的 评价行择期单节段腰椎内固定术的糖尿病患者围术期认知功能的改变及右美托咪定对其的影响。方法 行择期单节段腰椎内固定术、血糖控制良好的糖尿病患者60例,根据随机数字表法分为右美托咪定复合麻醉组(D组)和对照组(C组),每组20例。D组在给予常规诱导药物前15 min时开始静脉泵注右美托咪定0.5μg/kg,10 min后以0.5μg·kg^(-1)·h^(-1)持续输注至术闭前20 min;C组给予等量0.9%氯化钠溶液后给予常规麻醉诱导药物。于常规诱导药物给药前30 min(T_(0))、术闭时(T_(1))和术后1 d(T_(2))取外周静脉血样,使用血气分析仪测定血乳酸、血糖浓度、ELISA法测定血清肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、IL-10、C-反应蛋白(CRP)的浓度,ELISA法测定T_(0)和T_(2)时血清中S100β浓度。记录术前1 d、术后1 d和术后30 d的简易精神状态量表(MMSE)评分。记录患者术中相关情况。结果 与T_(0)相比,D组与C组在T_(1)的血乳酸、血糖、IL-10浓度升高(P<0.05),在T2的TNF-α、IL-6、IL-10、CRP及S100β浓度升高(P<0.05)。T_(2)时,D组的TNF-α、IL-6及S100β水平低于C组(P<0.05),IL-10水平高于C组(P<0.05)。与术前比较,D组与C组在术后1 d的MMSE评分均降低(P<0.05),且D组MMSE评分高于C组(P<0.05),D组术后1 d认知功能障碍的发生率低于C组(P<0.05),术后30 d的MMSE评分组间比较差异无统计学意义(P>0.05)。D组术中瑞芬太尼、丙泊酚用量少于C组(P<0.05)。结论 行择期单节段腰椎内固定术的糖尿病患者术后认知功能可出现一定程度的下降。右美托咪定可在一定程度上改善期早期的认知功能,可能与其减轻应激,抑制神经炎性反应有关。

Objective To evaluate the effect of dexmedetomidine on perioperative cognitive function in patients patients with diabetes mellitus(DM)undergoing elective internal fixation of the lumbar spine on single segment.Methods DM patients(n=60)with strict glucose control,who underwent elective single segment lumbar vertebrae internal fixation,were randomly assigned to dexmedetomidine-based anesthesia group(group D,n=30)or control group(group C,n=30).The Group D received intravenous infusion of Dex(0.5μg/kg)at 15min before conventional induction drugs,after 10 minutes,followed by a continuous infusion(0.5μg·kg-1·h-1)until 20min before the end of surgery;the group C received equivalent 0.9%sodium chloride,the peripheral venous blood samples were collected at 30min before conventional induction drugs(T0),at the end of operation(T1)and 1 day after surgery(T2)Blood lactate and blood sugar concentrations were measured by blood gas analyzer,enzyme-linked immunosorbent assay(ELISA)was performed to measure concentration of tumor necrosis factorα(TNF-α),interleukin-6(IL-6),IL-10,and C-reactive protein(CRP)and S100βat T0 and T2.The Mini Mental State Scale(MMSE)scores were recorded on 1 day before surgery,day 1 and 30 of postoperation.The intraoperative information was recorded.Results Compared with T0,the T1 concentrations of interleukin-10,lactic acid and blood glucose and the T2 ones of tumor necrosis factor-α,interleukin-6,interleukin-10,C-reactive protein and S100βwere raised(P<0.05).Compared with the day before surgery,MMSE score declined on day 1 in both groups(P<0.05),and the one of group D was higher than group C(P<0.05).The incidence of cognitive dysfunction in group D on day 1 was lower than in group C(P<0.05).There was no statistical differences of MMSE score between group D and group C on day 30(P>0.05).The intraoperative dosage of remifentanil and propofol in group D was lower than that in group C(P<0.05).Conclusion Diabetics undergoing elective spinal surgery may have the potential for cognitive decline after surgery.Dexmedetomidine-based anesthesia could partly improve these patients postoperative cognitions by alleviating stress and inhibiting neuroinflammatory response.