右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系  

RELATIONS OF THE CEREBRAL OXYGEN METABOLISM AND THE COGNITIVE FUNCTION AFTER COMBINED DEXMEDETOMIDINE ANESTHESIA OPERATION IN ELDERLY PATIENTS

作　　者：吕安庆[1] 陈文迪[1] 

机构地区：[1]浙江省绍兴市人民医院麻醉科,浙江绍兴312000

出　　处：《河北医科大学学报》2012年第3期299-301,共3页Journal of Hebei Medical University

摘　　要：目的探讨右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系。方法选取2009年12月—2011年6月期间在全身麻醉下行手术的老年患者100例,美国麻醉医师协会分级Ⅰ～Ⅲ级。随机分为2组,治疗组和对照组,各50例,采用简易智力状态检查表(mini-mental state examination,MMSE)对比评估2组患者术后6h,1、3d的认知功能。2组于麻醉诱导后即刻(T_0)、麻醉后60min(T_1)和麻醉恢复时(T_2)同步采集桡动脉和颈内静脉球部血样行血气分析,根据血红蛋白(hemoglobin,Hb)、动脉血氧饱和度(arterial oxygen saturation,SaO_2)、颈内静脉血氧饱和度(jugular venous oxygen saturation,SjvO_2)、动脉血氧分压(arterial partial prussure of oxygen,PaO_2)和颈内静脉血氧分压(jugular venous oxygen partial pressure,PjvO_2),计算脑血流量/脑氧代谢率比值(cerebral bloodflow to cerebral metabolic rate for oxygen,CBF/CMRO_2)。结果手术后6h、1d各组MMSE评分均有不同程度的降低(P<0.05);手术后6h、1d A组MMSE评分明显低于B组(P<0.05);A组T_0和T_1时,CBF/CMRO_2异常发生率明显降低,差异有统计学意义(P<0.05);Logistic逐步回归分析显示T_1时CBF/CMRO_2异常与老年患者术后认知功能障碍的发生有关(β=3.413,P<0.05)。结论全麻下老年患者脑氧代谢异常可能是认知功能障碍的诱导原因之一,右美托咪定可能通过调节脑氧代谢功能来改善术后认知功能。Objective To investigate the relations of the cerebral oxygen metabolism and the cognitive function after combined dexmedetomidine anesthesia operation in elderly patients. Methods One hundred patients aged over 60 years old were randomly divided into two groups： treatment group （ n = 50） and control group （ n = 50 ）. A battery of mini - mental state examination （ MMSE ） and neuropsychological tests were administered 6 hours, 1 day and 7 days after surgery. Blood samples were taken from artery and internal jugular vein simultaneously for blood gas analyses and determination of blood glucose immediately after anesthesia induction （T0） , 1 hour after anesthesia （T1） and anesthesia convalescence （T2）. The ratio of cerebral blood flow to cerebral metabolic rate for oxygen （CBF/ CMRO2 ） was calculated. Results MMSE scores were significantly lower in both groups after surgery. Compared with control group, MMSE score was obviously lower in treatment group 6 hour, 1day after surgery （P 〈0.05 ）. Moreover,there were significantly differences between two groups in CBF/CMRO2 at TO and T1. The Logistic analysis results indicate that the abnormal of CBF/CMRO2 was associated with the incidence of postoperative cognitive dysfunction （POCD） in elderly patients. Conclusion These data indicate that the dexmedetomidine could improve cerebral oxygen utilization during operation and alleviate some kind of cognitive dysfunction after surgery in elderly patients.

关 键 词：认知障碍 麻醉 全身 老年人 

分 类 号：R614.2[医药卫生—麻醉学]