右美托咪啶用于高血压老年患者术中镇静对术后认知功能的影响  

Influence of dexmedetomidine on postoperative cognitive function for intraoperative sedation in elderly patients with hypertension

作　　者：李宝永[1] 张树波[1] 张小平[1] 

机构地区：[1]河北联合大学附属医院麻醉科,唐山063000

出　　处：《山西医药杂志》2015年第8期862-866,共5页Shanxi Medical Journal

基　　金：河北省唐山市科技计划项目(14130213a)

摘　　要：目的探讨右美托咪啶用于高血压的老年患者术中镇静对术后认知功能的影响。方法选取本院2012年12月至2013年12月伴高血压的老年手术患者93例,采用随机数字表法分为3组,31例患者术中持续泵注右美托咪啶0.2μg·kg-1·h-1为低剂量组,31例患者术中持续泵注右美托咪啶0.5μg·kg-1·h-1为中剂量组,31例患者术中持续泵注右美托咪啶0.8μg·kg-1·h-1为高剂量组,采用简易精神状态量表(MMSE)评定认知功能,比较3组患者的镇静效果、意识恢复情况、术后认识功能状况、相关指标改变情况、不良反应情况。结果中剂量组不同时间点(停药0min、10min、30min、1h)Ramsay镇静评分、不同时间点(切皮时、术毕、术后1d)超氧化物歧化酶均明显高于低剂量组,自主呼吸恢复时间、睁眼时间、拔管时间、言语陈述时间、定向力恢复时间均明显晚于低剂量组,不同时间点(拔管后1、3h)MMSE评分、不同时间点(切皮时、术毕、术后1d)白细胞介素-6、干扰素γ、肿瘤坏死因子α、丙二醛、神经元特异性烯醇化酶、不良反应发生率均明显低于低剂量组。高剂量组不同时间点(停药0min、10min、30min、1h)Ramsay镇静评分、不同时间点(切皮时、术毕、术后1d)超氧化物歧化酶均明显高于低剂量组和中剂量组,自主呼吸恢复时间、睁眼时间、拔管时间、言语陈述时间、定向力恢复时间均明显晚于低剂量组和中剂量组,不同时间点(拔管后1、3h)MMSE评分、不同时间点(切皮时、术毕、术后1d)白细胞介素-6、干扰素γ、肿瘤坏死因子α、丙二醛、神经元特异性烯醇化酶、不良反应发生率均明显低于低剂量组和中剂量组。差异均有统计学意义(P<0.05)。结论高剂量右美托咪啶0.8μg·kg-1·h-1持续泵注,用于高血压老年患者术中镇静,可造成术后苏醒延迟,术后早期对认知功能有一定影响,但术后1d可恢复正常,对氧化应激损伤和炎症Objective To investigate the influence of dexmedetomidine on postoperative cognitive function for intraoperative sedation in elderly patients with hypertension .Methods Ninty‐three elderly operation patients with hypertension were selected in hospital from December 2012 to December 2013 ,who were randomly divided into three groups .Thirty‐one patients treated continuous infusion of dexmedetomidine 0 .2 μg· kg- 1·h - 1 were as low dose group .Thirty‐one patients treated dexmedetomidine 0 .5 μg· kg- 1·h - 1 were as middle dose group . Thirty‐one patients treated dexmedetomidine 0 .8 μg· kg- 1·h - 1 were as high dose group .Cognitive function was evaluated by mini mental state examination （MMSE） .Sedative effect ;consciousness recovery ;postoperative cog‐nition function ,changes of relevant indexes ;adverse reaction were compared among three groups？Results Ram‐say sedation score （withdrawal 0 min ,10 min ,30 min ,1 h） ;SOD（skin incision ,end of operation ,postoperative 1 d） in middle dose group were higher than those in low dose group .Spontaneous breathing recovery time ,open time ,extubation time ,verbal statement time ,orientation recovery time were later than those in low dose group . MMSE score（extubation 1 h ,3 h） ;IL‐6 ,interferon‐γ ,TNF‐α ,MDA ,NSE（skin incision ,end of operation ,post‐operative 1 d） ,incidence of adverse reaction were lower than low dose group .Ramsay sedation score （withdrawal 0 min ,10 min ,30 min ,1 h） ,SOD （skin incision ,end of operation ,postoperative 1 d） in high dose group were high‐er than low dose group and middle dose group ,spontaneous breathing recovery time ,open time ,extubation time , verbal statement time ;orientation recovery time were later than low dose group and middle dose group ,MMSE score（extubation 1 h ,3 h） ,IL‐6 ,interferon‐γ ,TNF‐α ,MDA ,NSE（skin incision ,end of operation ,postoperative 1 d） ,incidence of adverse reaction were lower than low dose group and middle dose group .Differenc

关 键 词：右美托咪啶 高血压 老年人 镇静 认知功能 

分 类 号：R614[医药卫生—麻醉学]