不同剂量右美托咪定对动脉瘤性蛛网膜下腔出血患者术后认知功能的影响

The effects of different doses of dexmedetomidine on postoperative cognitive function in patients with aneurysmal subarachnoid hemorrhage

目的观察不同剂量右美托咪定对动脉瘤性蛛网膜下腔出血患者术后认知功能的影响。方法选取动脉瘤性蛛网膜下腔出血患者90例为研究对象,根据不同治疗方法分为对照组(生理盐水联合瑞芬太尼)、低剂量组(低剂量右美托咪定联合瑞芬太尼)、高剂量组(高剂量右美托咪定联合瑞芬太尼),每组30例。采用ELISA法检测各组术前、术后1天血清神经功能指标S100β、神经元特异性烯醇化酶(NSE)和血管内皮功能指标内皮素-1(ET-1)和单核细胞趋化蛋白-1(MCP-1)水平。采用简易智力状态检查量表(MMSE)评估患者术前、术后3天认知功能。比较各组术中不良反应发生情况及术后认知功能障碍(POCD)的发生情况。结果术后3天,各组MMSE评分较术前降低(P<0.05),且高剂量组>低剂量组>对照组(P<0.05);高剂量组和低剂量组POCD发生率均低于对照组(P<0.05)。术后1天,各组S100β、NSE较术前升高(P<0.05),而ET-1和MCP-1较术前降低(P<0.05),且高剂量组<低剂量组<对照组(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定能改善动脉瘤性蛛网膜下腔出血患者术后认知功能,降低认知功能障碍的发生,以0.5 g/(kg·h)右美托咪定效果较好。

Aim To observe the effects of different doses of dexmedetomidine on postoperative cognitive function in patients with aneurysmal subarachnoid hemorrhage.Methods 90 patients with aneurysmal subarachnoid hemorrhage treated were divided into a control group(physiological saline combined with remifentanil),a low-dose group(low-dose dexmedetomidine combined with remifentanil),and a high-dose group(high-dose dexmedetomidine combined with remifentanil),according to different treatment methods,with 30 cases in each group.ELISA was used to detect the levels of serum neurological function index S100β,neuron specific enolase(NSE),vascular endothelial function index endothelin-1(ET-1),and monocyte chemotactic protein-1(MCP-1)in each group before and one day after surgery.The mini-mental state examination(MMSE)was used to evaluate the cognitive function of patients before and 3 days after surgery.The incidence of adverse reactions during surgery and the incidence of postoperative cognitive dysfunction(POCD)in each group were compared.Results Three days after surgery,the MMSE scores in each group were decreased compared with those before surgery(P<0.05),and in an order of high-dose group>low-dose group>control group(P<0.05).The incidence of POCD in both high-dose and low-dose groups was lower than that in the control group(P<0.05).On the first day after surgery,S100βand NSE in each group were increased compared with them before surgery(P<0.05),while ET-1 and MCP-1 were decreased compared with them before surgery(P<0.05),and in an order of high-dose group<the low-dose group<the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Dexmedetomidine can improve postoperative cognitive function and reduce the incidence of cognitive dysfunction in patients with aneurysmal subarachnoid hemorrhage.Infusing dexmedetomidine at a dose of 0.5 g/(kg·h)has a better effect.