右美托咪定对全麻老年患者术后认知功能障碍的影响  

Effects of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia

作　　者：张海山[1] 屈凤[1] 杜梅青[1] 王大龙[1] 葛维鹏[1] 郑观荣[1] 董红果[1] 王中伟[1] 孙志明[1] 张帅帅[1] 

机构地区：[1]山东省东营市胜利油田中心医院麻醉科,257034

出　　处：《中华麻醉学杂志》2014年第6期670-673,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价右美托咪定对全麻老年患者术后认知功能障碍（POCD）的影响。方法选择全麻患者90例，性别不限，年龄65～76岁，体重49-78kg，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将患者分为3组（n=30）：对照组（c组）和不同剂量右美托咪定组（D，组和D：组）。采用咪达唑仑-顺苯磺酸阿曲库铵．舒芬太尼．异丙酚行麻醉诱导，随后静脉输注右美托咪定负荷剂量0．5μg／kg，输注时间15min，然后以0．50μg·kg＾-1·h＾-1（D组）或O．75μg·kg＾-1·h＾-1（D2组）的速率静脉输注至术毕，C组给予等容量生理盐水。于术前1d、手术结束后1、3、7d时采集右颈内静脉血样，采用免疫比浊法测定血清C-反应蛋白（CRP）浓度、酶联免疫吸附法测定血清神经元特异性烯醇化酶（NSE）浓度。并于上述时点采用简易智能量表（MMSE）对患者进行认知功能测试，记录POCD的发生情况。结果与C组比较，D1组和D2组MMSE评分升高，血清CRP和NSE浓度降低（P〈O．01），D1组和D2组间上述指标差异无统计学意义（P〉0．05）。C组、D、组和D：组POCD发生率分别为30％、7％、7％，C组高于D。组、D：组（P〈0．05），D，组和耽组间差异无统计学意义（P〉0．05）。结论右美托咪定有助于预防全麻老年患者POCD的发生。Objective To evaluate the effects of dexmedetomidine on postoperative cognitive dysfunction （POCD） in the elderly patients undergoing general anesthesia. Methods Ninety ASA physical status Ⅱ or Ⅲ patients, aged 65-76 yr, weighing 49-78 kg, scheduled for elective surgery under general anesthesia, were randomly assigned into 3 groups （n = 30 each） ： control group （group C） and different doses of dexmedetomidine groups （D1 and D2 groups ）. Anesthesia was induced with midazolam, cisatracurium besilate, sufentanil and propofol. Dexmedetomidine 0.5/zg/kg was then intravenously infused over 15 min, followed by infusion at a rate of 0.50μg· kg^-1·h^-l（group D1 ） or 0.75 μg· kg^-1. h^-l（group D2 ） until the end of surgery. Group C received the equal volume of normal saline. At 1 day before surgery and 1, 3 and 7 days after surgery, venous blood samples were obtained for determination of serum concentrations of C-reactive protein （CRP） and neuron-specific enolase （NSE）. The cognitive function was evaluated by Mini-Mental State Examination （MMSE） at the time points mentioned above. The development of POCD was recorded. Results Compared with group C, the MMSE scores were significantly increased and serum concentrations of CPR and NSE were decreased in groups DI and D2, and no significant differences were found in the indexes mentioned above between D1 and D2 groups. The incidence of development of POCD in the elderly patients undergoing general anesPOCD was 30%, 7% and 7% in C, Dl and D2 groups, respectively. The incidence of POCD was significantly higher in group C than in D~ and D2 groups, and there was no significant difference between D~ and D2 groups. Conclusion Dexmedetomidine is helpful in preventing the thesia.

关 键 词：右美托咪啶 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学]