右美托咪定对全麻老年患者脑氧代谢的影响  

Effects of dexmedetomidine on cerebral oxygen metabolism in elderly patients undergoing general anesthesia

作　　者：魏兵华[1] 李长科[1] 徐明清[1] 詹潮勇[2] 

机构地区：[1]汕头大学医学院附属粤北人民医院麻醉科,广东省韶关市512026 [2]汕头大学医学院附属粤北人民医院心身医学科,广东省韶关市512026

出　　处：《中华麻醉学杂志》2013年第10期1177-1179,共3页Chinese Journal of Anesthesiology

基　　金：韶关市医药卫生科研计划项目（Y12140）;韶关市科技计划项目（2012CX/K60）

摘　　要：目的 评价右美托咪定对全麻老年患者脑氧代谢的影响.方法 择期全麻下行腹部手术老年患者50例,年龄60～ 87岁,体重44～ 74 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为2组（n=25）：对照组（C组）和右美托咪定组（D组）.D组于麻醉诱导前静脉泵注右美托咪定1.0μg/kg,输注时间20 min,C组给予等量生理盐水.于麻醉诱导前（T0）、气管插管后即刻（T1）、气管插管后10min（T2）及手术结束（T3）时经桡动脉、颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差（Da-jvO2）和脑氧摄取率（CERO2）.记录苏醒期躁动及术后谵妄的发生情况.结果 与T0时比较,两组T1-3时Da-jvO2和CERO2降低（P＜0.05）;与C组比较,D组T2-3时Da-jvO2和CERO2降低,苏醒期躁动和术后谵妄发生率减少（P＜0.05）.结论 右美托咪定可改善全麻老年患者的脑氧代谢,从而减少术后谵妄发生.Objective To evaluate the effects of dexmedetomidine on the cerebral oxygen metabolism in elderly patients undergoing general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 60-87 yr,scheduled for elective abdominal surgery under general anesthesia,were randomly divided into 2 groups （n =25 each） using a random number table：control group （group C） and dexmedetomidine group （group D）.Anesthesia was induced with iv injection of midazolam,fentanyl,atracurium and propofol.The patients were tracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0μg/kg was infused intravenously over 20 min before induction of anesthesia,while the equal volume of normal saline was given in group C.Before induction of anesthesia,at 0 and 10 min after tracheal intubation and at the end of operation （T0-3）,blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Arteriovenous blood O2 content difference （DajvO2） and cerebral O2 extraction rate （CERO2） were calculated at the same time.The development of emergence agitation and postoperative delirium within 48 h after surgery were recorded.Resets Compared with the baseline values at T0,the Da-jvO2 and CERO2 were significantly decreased at T1-3 in the two groups （P ＜ 0.05）.Compared with group C,the Da-jvO2 and CERO2 were significandy decreased at T2-3,and the incidence of emergence agitation and postoperative delirium within 48 h after surgery was decreased in group D （P ＜ 0.05）.Conclusion Dexmedetomidine can improve the cerebral oxygen metabolism and reduce the development of postoperative delirium in elderly patients undergoing general anesthesia.

关 键 词：右美托咪啶 老年人 代谢 脑 谵妄 

分 类 号：R614[医药卫生—麻醉学]