不同剂量的右美托咪定对胸腰椎及关节置换手术老年患者认知功能的影响  

Effects of different doses of dexmedetomidine on cognitive function in elderly patients undergoing thoracic and lumbar joint replacement

作　　者：金磊[1] 袁海军[1] 陈元良[1] JIN Lei YUAN Haijun CHEN Yuanliang(Department of Anesthesia, Central Hospital of Jinhua ,Zhejiang Province, Jinhua 321000, China)

机构地区：[1]浙江省金华市中心医院麻醉科,金华321000

出　　处：《中国临床药学杂志》2017年第2期123-126,共4页Chinese Journal of Clinical Pharmacy

摘　　要：目的观察不同剂量的右美托咪定对胸腰椎及关节置换手术老年患者认知功能的影响。方法选取2014年2月至2015年4月于我院接受治疗的76例胸腰椎体手术的老年患者。按照随机数表将患者分成低剂量组和高剂量组,各38例,在麻醉诱导期间均静脉泵入右美托咪定进行镇静,剂量分别为1~2μg·kg^(-1)。检测2组患者用药前后的听觉诱发电位指数(AAI)、改良警觉/镇静视觉评分(OAA/S)、简易智能精神状态(MMSE)、韦氏成人记忆量表及智力量表,以及认知功能障碍(POCD)。结果用药后,高剂量组AAI为6.1±1.7,OAA/S为0.3±0.1,均低于低剂量组的9.8±1.1和1.0±0.2,P<0.05;术后1、5 d高剂量组MMSE得分均高于低剂量组(24.3±2.1 vs 18.7±1.8,28.6±1.7 vs 24.1±2.3,P<0.05),POCD发生率低于低剂量组(28.9%vs 44.7%,7.9%vs 23.7%,P<0.05);韦氏成人记忆量表及智力量表中高剂量组累加、视觉再生、联想学习、数字广度,以及数字符号得分均高于低剂量组(P<0.05),联线实验得分较低剂量组较低(P<0.05)。结论使用右美托咪定进行患者的镇静时增加用量,能够有效提高麻醉效果并促进患者认知功能的恢复,推荐用量为2μg·kg^(-1)。AIM To observe the effects of different doses of dexmedetomidine on cognitive function in elder- ly patients undergoing thoracic and lumbar spine surgery. METHODS Totally 76 cases of elderly patients under- going thoracic and lumbar spine surgery from February 2014 to April 2015 in our hospital were selected and divided into low-dose group （ n = 38 ） and high-dose group（ n = 38） by the random number table. During the period of anes- thesia, the patients were induced intravenous infusion of dexmedetomidine for sedation, doses were 1 or 2 μg·kg-1 respectively. The a-line ARX index（AAI） , observer＇ s assessment of alert/sedation （OAA/S） , mini-mental state examination（MMSE） ,Wechsler memory scale and intelligence scale were detected before and after treatment. The incidence of postoperative cognitive dysfunction （POCD） was recorded after treatment. RESULTS After treat- ment, the AAI （6.1 ±1.7） and OAA/S （0.3 ±0.1） in the high-dose group, were lower than （9.8 ±1.1） and（1.0 ±0.2） in the low-dose group, P 〈0.05; MMSE scores after operation 1,5d in the high-dose group were higher than those in the low-dose group （24.3 ±2.1 vs 18.7 ± 1.8, 28.6 ± 1.7 vs 24. 1 ± 2.3, P 〈0.05）. The incidence of POCD after operation 1,5d in the high-dose group were lower than that in the low-dose group （28.9% vs 44.7% ,7.9% vs 23.7% ,P 〈 0.05）. By Wechsler memory scale and intelligence scale, the accumulation, vis- ual reproduction, associative learning, digit span and digit symbol scores in the high-dose group were higher than those in the low-dose group （P 〈 0.05） , but on-line test scores were lower than those in the low-dose group （P 〈 0. 05）. CONCLUSION The use of dexmedetomidine for sedation in patients with increased dosage can effective- ly improve the anesthetic effect and promote the recovery of cognitive function. The recommended dosage of dexme- detomidine is 2 μg·kg-1

关 键 词：剂量 右美托咪定 老年患者 认知功能 胸腰椎及关节置换手术 

分 类 号：R614[医药卫生—麻醉学]