术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响  

Changes in cerebral glucose metabolism induced by postoperative delirium in elderly patients and the effects of dexmedetomidine on it

作　　者：马昊[1] 欧阳文[1] 莫逸[2] 黎祖荣[3] 廖琴[1] 王懿春[3] 段开明[1] 陈明华[1] 廖炎[1] 

机构地区：[1]中南大学湘雅三医院麻醉科,长沙市410013 [2]湖南省肿瘤医院核医学科 [3]湖南省肿瘤医院ICU

出　　处：《中华麻醉学杂志》2012年第12期1417-1420,共4页Chinese Journal of Anesthesiology

基　　金：基金项目：国家自然基金面上项目（30871306）;中南大学湘雅三医院125人才工程

摘　　要：目的探讨术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响。方法择期全麻下行腹部手术的老年病人，性别不限，BMI19～25kg／m^2，年龄65～85岁，ASA分级Ⅰ或Ⅱ级。术后2d内评价谵妄的发生情况，将术后谵妄病人采用随机数字表法，随机分为谵妄组（D组，n=13）和右美托咪定组（Dex组，n=16）。另选术后没有发生谵妄的病人13例作为对照组（C组）。Dex组在谵妄发生后经10min静脉输注右美托咪定负荷量1μg／kg，随后以0．2～0．7μg·kg^-1·h^-1速率输注。谵妄发生期间采用^18氟-脱氧葡萄糖行正电子发射断层显像，分析双侧顶叶、颞叶和额叶葡萄糖标准摄取值，以反映葡萄糖代谢率。结果Dex组所有病人于给予右美托咪定后30min内控制了谵妄。术后谵妄病人脑葡萄糖代谢降低的脑区主要集中在顶叶、颞叶和额叶。D组和Dex组双侧顶叶、颞叶和额叶葡萄糖代谢率低于C组（P〈0．05）；Dex组双侧顶叶、颞叶、额叶葡萄糖代谢率高于D组（P〈0．05）。结论术后谵妄老年病人脑葡萄糖代谢率明显降低，右美托咪定可控制老年病人术后谵妄发生。Objective To investigate the changes in cerebral glucose metabolism induced by postoperative delirium in the elderly patients and the effects of dexmedetomidine on it. Methods Forty-two patients of both sexes aged 65-85 yr with a body mass index of 19-25 kg/m2 undergoing abdominal surgery under general anesthesia were enrolled in this study. Delirium occurred during the first 2 days after operation in 39 out of the 42 patients （29/42）. The 29 patients were randomly divided into 2 groups： group delirium without any treatment （group D, n = 13） and group delirium ＋ dexmedetomidine （group Dex, n = 16） . The remaining 13 patients did not develop delirium after operation and served as control group （group C）. In group Dex a loading dose of dexmedetomidine 1 μg/kg was administered iv over 10 min after occurrence of delirium followed by continuous infusion at 0.2-0.7 μg· kg^-1 . h^-1 . PET scan was performed within the time period in which delirium occurred, t8 Fluorlne-deoxyglucose was injected for observation of imaging of glucose metabolism. The standard uptake value of glucose of bilateral parietal, temporal and frontal lobes was calculated. Results Delirium was controlled within 30 min after admin- nistration of dexmedetomidine. Delirium significantly reduced cerebral glucose metabolism in the bilateral parietal, temporal and frontal lobes in group D as compared with group C （ P 〈 0.05） . Dexmedetomidine significantly attenuated the delirium-induced decrease in cerebral glucose metabolic rate of the 3 lobes in group Dex as compared＇with group D （ P 〈 0.05）. Conclusion Postoperative delirium reduces cerebral glucose metabolism and dexmedetomidine can significantly control pastoperative delirium in the elderly patients.

关 键 词：谵妄 手术后并发症 脑 葡萄糖 老年人 右美托咪啶 

分 类 号：R614[医药卫生—麻醉学]