右美托咪啶对老年患者在机器人辅助腹腔镜手术麻醉苏醒期及术后认知功能的影响  

Effects of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot-assisted laparoscopicradical prostatectomy in the elderly people

作　　者：丁玲玲[1] 张宏[1] 米卫东[1] 何艳[1] 张旭[2] 马鑫[2] 李宏召[2] 

机构地区：[1]中国人民解放军总医院麻醉手术中心,北京100853 [2]中国人民解放军总医院泌尿外科,北京100853

出　　处：《中南大学学报（医学版）》2015年第2期129-135,共7页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(30571792)~~

摘　　要：目的:评估右美托咪啶对老年患者在机器人辅助腹腔镜前列腺癌根治术麻醉苏醒期及术后认知功能的影响。方法:择期行机器人腹腔镜下前列腺癌根治术的患者100例,年龄65~80岁,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级I^III级,随机双盲分为对照组和右美托咪啶组,每组50例。右美托咪啶组将右美托咪啶以0.8μg/(kg·h)静脉泵注10 min,再以0.3μg/(kg·h)恒速维持至手术结束前30 min;对照组给予生理盐水。气腹建立后,所有患者采用40°Trendelenberg体位。观察记录患者手术结束时(T0)、苏醒时(T1)、拔管即刻(T2)、拔管10 min(T3)四个时间点的平均动脉压、心率、脑电双频指数(bispectral index,BIS)数值;对患者进行Ramsay镇静评分、术毕舒适度评分、术后谵妄分级量表评分和VAS评分;在术前1 d,术后第1天,术后第5天通过6个认知量表评估患者记忆、注意、神经运动反应速度多领域的认知功能测试及术后认知功能障碍(postoperative cognitive dysfunction,POCD)判断;患者于术前1 d,术后1 d,术后5 d采血以检查其神经元特异性烯醇化酶(neuron specific enolase,NSE)、血清肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)和白细胞介素-6(IL-6)的含量。结果:右美托咪啶组患者在T1和T2时刻平均动脉压、心率比对照组患者降低(P<0.05);与对照组比较,右美托咪啶组患者术后谵妄分级量表评分降低(P<0.05)、Ramsay镇静评分升高(P<0.05);术后1 d对照组17人,右美托咪啶组11人,术后5 d对照组12人,右美托咪啶组9人发生POCD;在术后1 d和术后5 d右美托咪啶组血清TNF-α,NSE,IL-6较对照组明显降低(P<0.05),右美托咪啶组血清SOD较对照组明显升高(P<0.05)。结论:右美托咪啶对老年患者在机器人辅助腹腔镜前列腺癌根治术麻醉苏醒期及术后有神经保护作用,其作用机制可能与右美托咪啶能减轻炎症反应有关。Objective: To evaluate the neuroprotective effect of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot assisted laparoscopicradical prostatectomy in the elderly people.Methods: A total of 100 elderly patients who under went robotic laparoscopic radical prostatectomy were divided into 2 groups: A dexmedetomidine group(n=50) and a control group(n=50). Patients in the dexmedetomidine group were given a loading dosage of dexmedetomidine [0.8 μg/(kg·h)] intravenously 10 min before the induction of general anesthesia followed by continuous infusion [0.3 μg/(kg·h)]. Patients in the control group were given 0.9% saline solution instead of dexmedetomidine. After pneumoperitoneum establishment, all patients adopted 40°trendelenberg position. MAP, HR, and BIS from each patient at the end of surgery immediately(T0), wake up(T1), extubation(T2), 10 min after extubation(T3) were monitored. Ramsay score, surgery comfort score, postoperative delirium score, and VAS scores were measured. At the time of preoperative 1 d, postoperative 1 d or 5 d, cognitive function was assessed and the concentration of neuron-specific enolase(NSE), tumor necrosis factor-α(TNF-α), superoxide dismutase(SOD) and interleukin-6(IL-6) were detected.Results: In the dexmedetomidine group, delirium rating scale was significantly smaller than that of the control group(P<0.05) while Ramsay sedation score was significantly greater than that of the control group(P<0.05). The levels of TNF-α, NSE, and IL-6 in the dexmedetomidine group were significantly reduced compared with those in the control group(P<0.05). The level of SOD in the dexmedetomidine group significantly elevated compared with that in the control group(P<0.05). Seventeen patients in the control group and 11 in the dexmedetomidine group displayed postoperative cognitive dysfunction(POCD) at the 1st day after surgery. Meanwhile, 12 patients in the control group and 9 in the dexmedetomidine group showed POCD at the 5th day after surgery(P<0.05)

关 键 词：右美托咪啶 机器人 Trendelenberg体位 术后认知功能障碍 神经保护 

分 类 号：R614[医药卫生—麻醉学]