乌司他丁联合右美托咪定对腹腔镜下老年结直肠癌手术患者术后认知功能障碍的影响  

The Effect of Dexmedetomidine Combining with Ulinastatin on the Postoperative Cognitive Dysfunction in Elderly Patients with Laparoscopic Colorectal Cancer Surgery

作　　者：尹彦玲[1] 马亚群[1] 马丽[1] 

机构地区：[1]北京军区总医院麻醉科,北京100700

出　　处：《医学综述》2016年第9期1842-1845,共4页Medical Recapitulate

摘　　要：目的探讨乌司他丁联合右美托咪定对腹腔镜下结直肠癌手术老年患者术后认知功能障碍(POCD)的影响。方法选择2013年1月至2014年12月北京军区总医院住院治疗的90例行腹腔镜下结直肠癌手术的老年患者为研究对象,采用随机数字表法分为3组:右美托咪定组(A组)、乌司他丁联合右美托咪定组(B组)以及对照组(C组),各30例。A组患者在手术麻醉诱导前泵入0.5μg/kg右美托咪定负荷剂量,后以0.3μg/(kg·h)的速度持续泵入,手术结束前30 min左右停止。B组患者同时给予右美托咪定和乌司他丁。而C组患者给予0.9%Na Cl注射液静脉泵入。监测术中出入量、手术时间、术后恢复时间、术中麻醉药物用量、恢复期不良反应,并统计术后第1日和第3日POCD的发生率。结果 B组丙泊酚的使用量明显低于A组和C组[(607±173)mg比(622±152)mg、(932±257)mg]。A组患者睁眼时间延长,显著高于B组和C组[(7.1±2.6)min比(6.0±2.9)min、(1.6±0.4)min](P<0.05)。C组患者术后1 d、3 d简易智力状态检查法(MMSE)评分为(23.4±5.4)分、(25.9±5.1)分,术前为(26.5±2.7)分,术后1 d显著低于术前(P<0.05)。其他各组患者术前术后MMSE评分未见明显改变(P>0.05)。在POCD的发生率方面,C组患者术后1 d POCD发生率为33.3%(10/30),显著高于A组[16.6%(5/30)]、B组[6.6%(2/30)],差异有统计学意义(P<0.05)。结论乌司他丁联合右美托咪定可以有效降低腹腔镜下结直肠癌手术老年患者POCD的发生率,是临床预防POCD的有效途径之一。Objective To evaluate the effect of dexmedetomidine combining with ulinastatin on the postoperative cognitive dysfunction（POCD） in elderly patients with Laparoscopic colorectal cancer surgery. Methods Ninety elderly patients with laparoscopic colorectal cancer surgery in General Hospital of Beijing Military Region from Jan. 2013 to Dec. 2014 were enrolled in these study and divided into three groups according to the random number table method：Dex group （A）, Dex ＋ Uli group （B） and control group （C）, 30 cases each. Group A was pumped into the 0. 5 μg/kg dexmedetomidine before the induction of anesthesia, then reduced to 0. 3 μg/（kg , h） speed for continuous infusion till approximately 30 min before the end of the operation. Group B was given dexmedetomidine and UTI. And group C was treated with 0. 9% NaCl injection by intravenous infusionThe intraoperative intake and output, operation time, postoperative recovery time, the dosage of anesthetic drugs, adverse reactions during the recovery period, and the incidence of POCD at postoperative first and third day were monitored. Results The usage amount of propofol of group B was significantly lower than group A and group C [ （607 ± 173 ） mg vs （622 ± 152） rag, （932 ± 257 ） mg ]. Eye opening of group A was significantly longer than group B and group C [ （ 7. 1 ± 2. 6 ） rain vs （ 6. 0 ± 2. 9 ） rain, （ 1.6 ± 0. 4） min ] （ P 〈 0.05 ）. Postoperative 1 d, 3 d MMSE score of group C was （ 23.4 ± 5.4 ） scores, （ 25.9 ± 5.1 ） scores, and before operation was （ 26. 5 ± 2. 7 ） scores, and the postoperative 1 d score was significantly lower than the preoperative（ P 〈 0.05 ）. Other groups＇ MMSE scores did not change signifi- cantly before and after surgery（ P 〉 0. 05 ）. The postoperative 1 d incidence of POCD of group C was 33.3% （ 10/30）, significantly higher than the group A [ 16.6% （ 5/30 ） ± and group B [ 6. 6% （ 2/30 ） 1 （ P 〈 0. 05 ）. Conclusion The administration of d

关 键 词：术后认知功能障碍 老年患者 右美托咪定 乌司他丁 

分 类 号：R735[医药卫生—肿瘤]