右美托咪定对腹腔镜胆囊切除术中CO_2气腹不同压力水平下老年患者术后认知功能的影响  

Effect of dexmedetomidine in postoperative cognitive function undergoning laparoscopic cholecystectomy in different levels of carbon dioxide pneumoperitoneum in old patients

作　　者：范薇[1] 孙勇[2] 张钧[1] 李金玉[1] 

机构地区：[1]南京医科大学附属淮安第一医院麻醉科,江苏省淮安市223300 [2]南京医科大学附属淮安第一医院烧伤整形科,江苏省淮安市223300

出　　处：《实用医学杂志》2015年第21期3577-3580,共4页The Journal of Practical Medicine

基　　金：2012年度淮安市科技支撑计划(社会发展)基金资助项目(编号:HAS2012024)

摘　　要：目的:探讨右美托咪定(DEX)对腹腔镜胆囊切除术(LC)中CO_2气腹不同压力水平下老年患者术后认知功能及血清NSE和S100β含量的影响。方法:120例行LC老年患者随机分为A,B,C,D组。气腹压力A,C组15 mmHg,B,D组10 mmHg。C、D组在常规全麻基础上加用DEX,A、B组给予等容生理盐水。于术前1d和术后第1、3、5天测定简易精神状态量表(MMSE)评分并记录术后POCD的发生情况,检测术前1d、诱导前、气腹完成时、气腹20 min后、术毕、术后第1、3、5天血清NSE和S100β含量。结果:术后第1、3、5天,D组MMSE评分较A、B、C组升高(P<0.05)。C、D组术后第1、3、5天POCD发生率较A组下降(P<0.05)。从气腹完成时至术后第5天D组血清NSE和S100β含量较其余3组降低(P<0.05)。结论:低气腹压力水平下DEX可改善LC术后老年患者认知功能,降低血清NSE和S100β含量。Objective To investigate the effects of dexmedetomidine （DEX） in postoperative cognitive function and serum contents of NSE and S10015 undergoning laparoscopic choleeystectomy （LC） in different lev- els of carbon dioxide pneumoperitoneum in old patients. Methods One hundred and twenty elderly patients scheduled for LC were randomly divided into A, B, C and D groups. Pressure of CO2 was kept 15 mmHg in A and C groups, 10 mmHg in B and D groups. DEX was applied in C and D groups on the basis of routine general anesthesia, while the equal volume normal saline was given in A and B groups. Cognitive function was measured by mini-mental state examination （MMSE） and the incidence rate of cognitive dysfunction （POCD） at 1 day before operation and 1 day, 3 days, 5 days after operation. The serum contents of NSE and S100β were determined at 1 day before operation, before induction, finished of pneumoperitoneum, 20 min after pneumoperitoneum, the end of operation and 1 day, 3 days, 5 days after operation. Results MMSE scores in the D group were higher than that of the other three groups at 1 day, 3 days, 5 days after operation （P 〈 0.05）. Compared with A group, incidence rate of POCD in C and D groups was obviously decreased at 1 day, 3 days, 5 days after operation （P 〈 0.05）. The levels of NSE and S100β in D group were lower than A, B and C groups from the completion of pneumoperitoneum to 5 days after operation （P 〈 0.05）. Conclusion DEX under lower pneu- moperitoneum pressure can improve postoperative cognitive function, decrease the serum contents of NSE and S100β undergoning laparoscopic cholecystectomy in old patients.

关 键 词：右美托咪定 腹腔镜胆囊切除术 术后认知功能障碍 神经元特异性烯醇化酶 S100Β 

分 类 号：R614[医药卫生—麻醉学]