右美托咪定对老年患者全麻术后认知功能及炎症因子的影响  

Clinical analysis of effect of Dexmedetomidine on postoperative cognitive function and preoperative inflammation in the elderly patients undergoing general anesthesia

作　　者：孟海兵[1] 来伟[1] 帅君[1] 丁国友[1] 

机构地区：[1]解放军第94医院麻醉科,江西省南昌市330002

出　　处：《实用医学杂志》2014年第14期2300-2301,共2页The Journal of Practical Medicine

基　　金：江西省卫生厅科技计划(编号:20132086)

摘　　要：目的:观察右美托咪定(DEX)对老年患者全麻术后认知功能和炎症因子的影响。方法:选择我院进行全麻手术的老年患者70例,随机分为观察组和对照组,观察组在常规全麻基础上加用DEX,对照组给予相应生理盐水,于手术前1天和手术后第1、3、5、7天进行简易智力状态测试(MMSE),进行评分并计算术后认知功能障碍(POCD)发生率,并分别于麻醉前、切皮时、手术结束时和术后1 h测定两组患者血清白介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平。结果:术后1和3 d,观察组MMSE评分均显著高于对照组(P<0.05);观察组POCD发生率均显著低于对照组(P<0.05)。术中切皮时和手术结束时,两组患者IL-6和TNF-α水平均较麻醉前明显升高(P<0.05),观察组均显著低于对照组(P<0.05),术后1 h观察组IL-6和TNF-α水平降至麻醉前水平,而对照组IL-6和TNF-α水平仍显著高于麻醉前,亦高于观察组(P<0.05)。结论:DEX可降低老年患者全麻术后早期POCD的发生率,其作用机制之一可能为降低炎症反应。Objective To study the effect of dexmedetomidine （DEX） on postoperative cognitive function and preoperative inflammation in the elderly patients undergoing general anesthesia. Methods 70 elderly patients undergoing general anesthesia operation were chosen and divided into observation group and control group randomly. DEX and physiological saline were applied in observation group on the basis of routine general anesthesia. The cognitive function of patients in both groups were tested by mini-mental state examination （MMSE） and the incidence rate of cognitive dysfunction （POCD） were measured at 1 day before surgery, 1 day, 3 days, 5 days, and 7 days after surgery. The level of interleukin-6 （IL-6） and tumor necrosis factor-α（TNF-α） were tested before anesthesia, during skin incision, rightly after operation and 1h after operation. Results MMSE scores were significantly higher and the incident rates of POCD were lower in observation group than those in control group at 1 day and 3 days after surgery （P〈0.05）. The levels of IL-6 and TNF-αincreased obviously during skin incision and postoperative period, and they were significantly lower in observation group （P〈0.05）. The levels of IL-6 and TNF-αdecreased to the levels before anesthesia in observation group, and were still much higher in control group than that of preanesthesia （P 〈 0.05）. Conclusions DEX infusion intraoperatively may effectively decrease the incidence of early POCD, whose mechanism could be reducing inflammation response.

关 键 词：右美托咪定 老年 认知功能 TNF-Α IL-6 TNF-Α IL-6 

分 类 号：R614.2[医药卫生—麻醉学]