右美托咪定对非体外循环冠状动脉旁路移植术后患者认知功能障碍发生的影响  

Effect of dexmedetomidine on cognitive dysfunction after off-pump coronary artery bypass grafting

作　　者：陈小莉[1] 何睿林[2] 谭冠先[3] 王彩娥[2] 魏利娟[1] 马亚飞[1] 韩艳艳[1] 

机构地区：[1]河南科技大学第一附属医院麻醉科,洛阳市471003 [2]河南科技大学第一附属医院临床药学科,洛阳市471003 [3]广西医科大学第一附属医院麻醉科

出　　处：《中华麻醉学杂志》2013年第5期548-550,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价右美托咪定对患者非体外循环冠状动脉旁路移植术后患者认知功能障碍发生的影响。方法择期非体外循环冠状动脉旁路移植术患者58例，性别不限，ASA分级Ⅱ或Ⅲ级，年龄51～63岁，采用随机数字表法分为2组（n=29）：对照组（C组）和右美托咪定组（D组）。两组麻醉诱导及麻醉维持方法相同。D组于气管插管后静脉输注右美托咪定负荷剂量1μg／kg，泵注时间15min，继之以0．5μg·kg^-1·h^-1的速率输注至术毕，C组静脉输注等容量生理盐水。于麻醉诱导前24h和术后24、48和72h时记录患哲MMSE评分，判断术后72h内认知功能障碍的发生情况，记录术中舒芬太尼用量和气管拔管时间。结果与c组比较，D组术后24和48h时MMSE评分升高，术后72h内认知功能障碍发生率降低（P〈0．05），术中舒芬太尼用量和气管拔管时间差异无统计学意义（P〉0．05）。结论右美托咪定可明显降低非体外循环冠状动脉旁路移植术后患者认知功能障碍的发生。Objective To investigate the effect of dexmedetomidine on cognitive dysfunction after off- pump coronary artery bypass grafting in patients. Methods Fifty-eight ASA physical status II or III patients, aged 51-63 yr, weighing 52-83 kg, undergoing off-pump coronary artery bypass grafting, were randomly divided into 2 groups （n = 29 each）： control group （group C） and dexmedetomidine group （group D）. Anesthesia was induced with midazolam, etomidate, sufentanil and pipecuronium. The patients were thracheal intubated and mechanically ventilated. Anesthesia was maintained with propofol, sufentanil, isofiurane and pipecuronium. A loading dose of dexmedetomidine 1 /~g/kg was infused over 15 min after tracheal intubation, followed by dexmedetomidine infusion at 0.5μg·kg^-1·h^-1 until the end of operation in group D, while the equal volume of normal saline was infused in group C. Cognitive function was assessed by Mini-Mental State Examination （MMSE） at 24 h before operation and 24, 48 and 72 h after operation. The development of postoperative cognitive dysfunction was recorded within 72 h after operation. The consumption of sufentanil and extubation time after extubation was recorded. Results Compared with group C, MMSE scores at 24 and 48 h after operation were significantly increased and the incidence of postoperative cognitive dysfunction within 72 h after operation was decreased （ P 〈 0.05 ）, and no significant change was found in the consumption of sufentanil and extubation time in group C （ P 〉 0.05 ）. Conclusion Dexmedetomidine can decrease the development of postoperative cognitive dysfunction after off-pump coronary artery bypass grafting in patients.

关 键 词：右美托咪啶 冠状动脉旁路移植术 非体外循环 认知功能 

分 类 号：R614[医药卫生—麻醉学]