右美托咪定对颈动脉内膜剥脱术老年患者术后认知功能的影响  

Effects of dexmedetomidine on postoperative cognitive function in aged patients undergoing carotid endarterectomy

作　　者：葛亚丽[1] 龙丰云[1] 郭芳[1] 方向志 高巨[1] 

机构地区：[1]江苏省苏北人民医院麻醉科,扬州市225001

出　　处：《中华麻醉学杂志》2014年第11期1303-1305,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价右美托咪定对颈动脉内膜剥脱术老年患者术后认知功能的影响.方法 择期颈动脉内膜剥脱术患者40例,年龄65～80岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组（n=20）：空白对照组（C组）和右美托咪定组（DEX组）.DEX组麻醉诱导前静脉输注右美托咪定负荷量0.03 μg· kg-1·min-1（10 min）,气管插管后静脉输注右美托咪定0.30 μg· kg-1·h-1至手术结束前30 min,C组给予等容量的生理盐水.于术前1 d（T0）、术后6 h（T1）、术后24 h（T2）时采集静脉血样,应用ELISA法测定血清脑源性神经营养因子（BDNF）浓度,并于T0、T2、术后48 h（T）、72 h（T4）、7 d（T5）、1个月（T6）时应用简易智能量表（MMSE）评估认知功能.结果 与T0时比较,2组T1时血清BDNF浓度升高,C组T2.3时MMSE评分降低,DEX组T2时MMSE评分降低,血清BDNF浓度升高（P＜0.05）.与C组比较,DEX组T3,4时MMSE评分升高,T2时血清BDNF浓度升高（P＜0.05）,T5,6时MMSE评分差异无统计学意义（P＞0.05）.结论 右美托咪定有助于改善颈动脉内膜剥脱术老年患者术后早期认知功能,促进术后认知功能恢复,可能与其增强机体内源性BDNF的生成有关.Objective To evaluate the effects of dexmedetomidine on postoperative cognitive function in the aged patients undergoing carotid endarterectomy.Methods Forty patients,aged 65-80 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective carotid endarterectomy,were randomly divided into 2 groups （n =20 each）：control group （group C） and dexmedetomidine group （group DEX）.Anesthesia was induced with midazolam,etomidate,fentanyl and rocuronium.The patients were tracheally intubated.In group DEX,a loading dose of dexmedetomidine 0.03 μg· kg-1 ·min-1 was infused intravenously for 10 min starting from the time point before induction,and dexmedetomidine 0.30μg· kg-1 ·min-1 was infused until 30 min before the end of operation starting from the end of intubation.The equal volume of normal saline was given instead of dexmedetomidine in group C.At 1 day before operation （To） and 6 and 24 h after operation （T1.2）,venous blood samples were collected for determination of serum brain-derived neurotrophic factor （BDNF） concentrations.The cognitive function of the patients was assessed using Mini-Mental State Examination （MMSE） at To,T2,and 48 h,72 h,7days and 1 month after operation （T3-6）.Results Compared with the baseline value at T0,the serum BDNFconcentrations were significantly increased at T1 in the two groups,MMSE scores were decreased at T2,3 in groupC,and MMSE scores were decreased,and the serum BDNF concentrations were increased at T2 in group DEX.Compared with group C,the MMSE scores were significantly increased at T3.4,the serum BDNF concentrations were increased at T2,and no significant change was found in MMSE scores at T5.6 in group DEX.Conclusion Dexmedetomidine is helpful in improving postoperative cognitive function and in promoting the recovery of postoperative cognitive function,and the mechanism may be related to enhanced production of endogenous BDNF in the aged patients undergoing carotid endarterectomy.

关 键 词：右美托咪啶 颈动脉内膜切除术 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学]