右美托咪定对老年脆弱脑功能患者术后认知功能的影响  

Effect of dexmedetomidine on postoperative cognitive function in elderly patients with fragile brain

作　　者：汤莉莉[1] 顾尔伟[1] 张雷[1] 刘训芹[1] 曹袁媛[1] 程新琦[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥市230032

出　　处：《中华麻醉学杂志》2016年第2期140-143,共4页Chinese Journal of Anesthesiology

基　　金：安徽省科技攻关计划项目（1301042204）

摘　　要：目的评价右美托咪定对老年脆弱脑功能患者术后认知功能的影响。方法择期拟行胃肠手术的脆弱脑功能患者120例，年龄65—85岁，体重50～80k，性别不限，ASA分级Ⅱ或Ⅲ级，术前简易智力状态量表评分≥20分，采用随机数字表法分为2组（n=60）：对照组（C组）和右美托咪定组（D组）。采用多模式监测下异丙酚全凭静脉麻醉。D组于麻醉诱导前经10min静脉输注负荷剂量右美托咪定0．4μg／kg，然后以0．4μg·kg^-1·h^-1的速率静脉输注至手术结束前30min；C组给予等容量生理盐水。采用谵妄评估量表评估术后3d内谵妄的发生情况，采用简易智力状态量表评估术后7d认知功能障碍的发生情况。结果与C组比较，D组术后3d内谵妄发生率降低（P〈0．05），术后7d认知功能障碍发生率差异无统计学意义（P〉0．05）。结论右美托咪定可降低老年脆弱脑功能患者术后谵妄的发生。Objective To evaluate the effect of dexmedetomidine on the postoperative cognitive function in the elderly patients with fragile brain. Methods One hundred and twenty elderly patients with fragile brain, aged 65-85 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination score ≥20, scheduled for elective gastroenterie surgical procedures, were randomly assigned to one of 2 groups （ n = 60 each） using a random number table： control group （group C） and dexmedetomidine group （group D）. In group D, dexmedetomidine was intravenously infused in a loading dose of 0.4 μg/kg over 10 min before anesthesia induction, followed by an infusion of 0.4 μg·kg^-1·h^-1until 30 min before the end of surgery. While the equal volume of 0.9% nomal saline was given instead of dexmedetomidine in group C. Postoperative delirium was assessed within 3 days after operation using Confusion Assessment Method. Postoperative cognitive dysfunction was assessed at 7 days after operation using Mini-Mental State Examination. Results Compared with group C, the incidence of postoperative delirium was significantly decreased within 3 days after operation （P〈 0.05）, and no significant change was found in postoperative cognitive dysfunction at 7 days after operation in group D （P〉0.05）. Conclusion Dexmedetomidine can decrease the occurrence of postoperative delirium in the elderly patients with fragile brain.

关 键 词：右美托咪啶 谵妄 认知障碍 老年人 脆弱脑功能 

分 类 号：R614[医药卫生—麻醉学]