右美托咪定在老年胸腔镜手术中的镇静效果及对患者术后认知功能的影响

Sedative effect of dexmedetomidine on elderly thoracoscopic surgery and its influences on postoperative cognitive function

目的探究右美托咪定(dexmedetomidine,Dex)在老年胸腔镜手术中的效果及对患者术后认知功能的影响。方法选择行胸腔镜手术的老年患者100例作为研究对象,用随机数字表法分为观察组和对照组,每组50例。观察组在脑电双频谱指数(bispectral index,BIS)监测下给予右美托咪定,对照组用氯化钠溶液。观察2组手术时间、失血量、拔管时间及术毕苏醒时间、镇静评分、术后疼痛[视觉模拟评分法(visual analogue scale,VAS)]、睡眠质量,比较2组术前及术后1、3 d的认知功能[简易精神状态检查表(mini-mental state examination,MMSE)],比较2组术前及术后1 d的血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、中枢神经特异蛋白(S100 calcium binding proteinβ,S100β)水平,记录术后1 d 2组不良反应的发生情况。结果2组患者的手术时间及失血量比较,差异均无统计学意义(P>0.05);观察组的拔管时间及术毕苏醒时间均短于对照组(P<0.05);观察组的术后VAS、睡眠质量评分均低于对照组(P<0.05),镇静评分高于对照组(P<0.05);术后1、3 d,观察组的MMSE评分均高于对照组(P<0.05);术后1 d,观察组的S100β、NSE水平均低于对照组(P<0.05);术后1 d,观察组的不良反应发生率(24.00%)低于对照组(38.00%),P<0.05。结论Dex在老年胸腔镜手术中具有较好的镇静效果,对患者术后认知功能的影响较小,且能缩短拔管时间及术毕苏醒时间,患者的术后疼痛较轻,睡眠质量较高,能降低术后S100β、NSE水平,且不良反应较少。

Objective To investigate the effect of dexmedetomidine(Dex)on elderly thoracoscopic surgery and its effect on postoperative cognitive function.Methods A total of 100 elderly patients undergoing thoracoscopic surgery were enrolled.According to random number table method,they were divided into an observation group and a control group,50 cases in each group.The observation group was treated with Dex under bispectral index(BIS)monitoring,while the control group was treated with sodium chloride solution.The operation time,blood loss,extubation time,postoperative awaking time,the scores of sedation,postoperative pain[visual analogue scale(VAS)]and sleep quality in both groups were observed.The cognitive function[mini-mental state examination(MMSE)]before surgery and on the 1 day and 3 days after surgery,the levels of serum neuron-specific enolase(NSE)and S100 calcium binding proteinβ(S100β)before surgery and on the 1 day after surgery were compared between the 2 groups.The occurrence of adverse reactions in the 2 groups on the 1 day after surgery was recorded.Results There was no significant difference in operation time or blood loss between the 2 groups(P>0.05).The extubation time and postoperative awaking time in observation group were shorter than those in control group(P<0.05).The scores of postoperative VAS and sleep quality in the observation group were lower than those in control group(P<0.05),while the sedation score was higher than that in the control group(P<0.05).On the 1 day and 3 days after surgery,MMSE scores in observation group were higher than those in control group(P<0.05).On the 1 day or after surgery,the levels of S100βand NSE were lower in the observation group than in the control group(P<0.05).On the 1 day after surgery,the incidence of adverse reactions in the observation group was lower than that in control group(24.00%vs.38.00%),P<0.05.Conclusion The sedative effect of Dex is good on elderly thoracoscopic surgery,with few effects on postoperative cognitive function.It can also shorten extubation time and postoperative awaking time,and reduce the levels of S100βand NSE,with milder postoperative pain,higher sleep quality and few adverse reactions.