右美托咪啶对老年手术患者血清S-100β蛋白、NSE浓度的影响  

Effect of Dexmedetomidine on the Serum Concentrations of S-100β Protein and NSE in Elderly Patients Undergoing Surgery

作　　者：杨云丽[1] 张承华[1] 邓玫 赵珍[3] YANG Yun-li ZHANG Cheng-hua DENG Mei ZHAO ZHen(Dept. of Anesthesiology, Kunming General Hospital of Chengdu Military Area, Kunming Yunnan 650032 Dept. of Anesthesiology, The First People＇s Hospital of Qujing, Qujing Yunnan 655000 Kunming Medical University, Kunming Yunnan 650500, China)

机构地区：[1]成都军区昆明总医院麻醉科,云南昆明650032 [2]曲靖市第一人民医院麻醉科,云南曲靖655000 [3]昆明医科大学,云南昆明650500

出　　处：《昆明医科大学学报》2016年第7期58-61,共4页Journal of Kunming Medical University

基　　金：云南省应用基础研究基金资助项目(2010ZC179)

摘　　要：目的评价右美托咪啶对老年手术患者血清S-100B蛋白、NSE浓度的影响．方法选择髋关节置换术老年患者100例，ASA分级Ⅱ或Ⅲ级，性别不限，年龄65～75岁，体重指数〈25kg／m2．采用随机数字表法，将患者分为2组n=50）：生理盐水对照组（C组）和右美托咪啶组（D组）．D组麻醉诱导前经15min静脉注射右美托咪啶0．5I,zg／kg，随后以0．4μg／（kg·h）的速率静脉输注至术毕前30min，C组给予等容量生理盐水．5min后静脉注射舒芬太尼0．4λg／kg、丙泊酚1-2mg／kg、罗库溴铵0．6mg／kg麻醉诱导，气管插管后行机械通气．靶控吸入七氟醚呼气末靶浓度1％-3％、静脉输注舒芬太尼0．2μg（kg·h）维持麻醉，术中维持BIS值40-60．于麻醉诱导前（T0）、术毕（T1）、术后12h（T2）时采集颈内静脉血样，采用ELISA法测定血清S-100B蛋白和NSE浓度．术毕待拔除气管导管后送术后监护病房．采用ICU谵妄评估法对患者进行谵妄评测，记录术后24h内谵妄的发生情况．结果与T0时比较，2组T1～2时血清S-100β蛋白、NSE浓度升高；与C组比较，D组丙泊酚和七氟醚用量减少、T1—2时血清S-100β蛋白和NSE浓度降低、术后24h内谵妄的发生率降低（P〈0．05）．结论右美托咪啶可降低血清S-100β蛋白、NSE的浓度，降低老年患者术后谵妄的发生，提示其有脑保护效应．Objective To investigate the effect of dexmedetomidine on the serum concentrations of S-100β protein and neurone specific enolase （NSE） in elderly patients undergoing surgery. Methods One hundred ASA Ⅱ or m patients, aged 65 -75 yr with a body mass index of 〈25 kg/m2, scheduled for elective hip joint replacement surgery under general anesthesia, were randomly divided into 2 groups （n =50） ： control group （group C） and dexmedetomidine group （group D） . Dexmedetomidine 0.5 μg/kg was infused intravenously over 15 min before anesthesia induction in group D and was maintained 0.4 μg/（kg·h） until 30 min before operation end, while the same volume of normal saline was infused in group C. Anesthesia was induced by iv injection of sufentanil 0.4μg/kg and propofol 1 - 2 mg/kg until loss of consciousness. Tracheal intubation was facilitated with 0.6 mg/kg roeuronium bromide and the patients were mechanically ventilated. Anesthesia was maintained with sevoflurane by target controlled inhalation （TCI） （end-tidal concentration set at 1%-3%） and snfentanil 0.2μg/（kg·h） in both groups. BIS was maintained at 40 - 60 during operation.Venous blood samples were obtained for determination of serum concentrations of S-100β protein and NSE before anesthesia （baseline） , operation end and at 12h after operation. Patients were sent to Intensive Care Unit when operation end. All the patients were assessed for the development of delirium by experience research staff using Confusion Assessment Method for Intensive Care Unit. The incidence of postoperative delirium within 24h after operation were recorded, and compared between the two groups. Results The serum concentrations of S-100β protein and NSE was significantly increased at T1-2 than at TO in two groups. The total close of each anesthetic （propofol, sevoflurane） , the serum concentrations of S-100β protein and NSE, and the incidence of postoperative delirium were significantly lower in group D than in group C （P〈 0.05） . C

关 键 词：右美托咪啶 S-100Β蛋白 NSE 谵妄 手术后并发症 老年 

分 类 号：R614[医药卫生—麻醉学]