不同时点右美托咪定对全凭七氟醚麻醉患者围拔管期应激与认知功能的影响  

Influence of Different Time Points For Dexmedetomidine on Extubation Stress and Cognitive Function After Surgery in Patients Undergoing Sevoflurane Anesthesia

作　　者：贾力维[1] 王君艳[2] 白栓成[2] 扈艳[2] JIA Li - wei WANG Jun- yan BAI Suan- cjeng HU Yan(Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Baotou 014030 China Baotou Central Hospital, Baotou 014030 China)

机构地区：[1]内蒙古科技大学包头医学院,内蒙古包头014030 [2]包头市中心医院,内蒙古包头014040

出　　处：《内蒙古医学杂志》2017年第5期519-522,F0002,共5页Inner Mongolia Medical Journal

摘　　要：目的探讨三个不同时点泵注右美托咪定对全凭七氟醚麻醉腹腔镜胆囊切除术老年患者围拔管期应激与认知功能的影响。方法选择择期腹腔镜胆囊切除术老年患者100例,随机分为4组:对照组(C组)、麻醉前20 min泵注右美托咪定组(D1组)、插管后泵注右美托咪定组(D2组)、拔管前20 min泵注右美托咪啶组(D3组),每组25例。对照组于麻醉诱导前20 min泵入同等容量的生理盐水,D1、D2、D3组均泵注0.4μg/kg(根据药物使用说明书及临床应用指导意见,10 min泵入)右美托咪定。于使用药物前(T1)、自主呼吸恢复时(T2)、拔管即刻(T3)、拔管后5 min(T4)、拔管后15 min(T5)记录患者的HR、MAP和Riker镇静和躁动评分(SAS);用蒙特利尔认知评估量表(MoCA)对患者术前1 d、术后1、3 d认知功能进行评定并比较术后认知功能障碍发生率。结果 4组患者年龄、BIM、麻醉时间、受教育程度、术中输液量与出血量比较差异无统计学意义(P>0.05);与D1组比较,D2组各时点HR、MAP、Riker镇静和躁动评分(SAS)差异无统计学意义(P>0.05),D1与D2组T3~T5时点HR、MAP、Riker镇静和躁动评分(SAS)有所升高但差异无统计学意义(P>0.05);D3组T2~T5各时点HR、MAP无明显升高,Riker镇静和躁动评分(SAS)较低;对照组T2~T4时点HR、MAP和Riker镇静和躁动评分(SAS)明显升高,且差异有显著性统计学意义(P<0.01)。4组患者术前1 d认知功能比较差异无统计学意义(P>0.05);4组患者在术后1 d认知功能有所下降,术后与术前比较,差异有统计学意义(P<0.05);D1、D2、D3组患者术后1 d认知功能障碍发生率低于对照组(P<0.05);术后3 d对照组患者仍有32%存在POCD,还有2例处于中度认知障碍,D1组患者仅有8%存在POCD,D2组患者有16%存在POCD,D3组患者有20%存在POCD,以上3组发生POCD的患者均已恢复到轻度认知障碍。结论 D1、D2、D3组均能降低围拔管期应激及术后认知功能的改变,但D1组对围拔管期应激Objective To explpore the influence of three different time points（20 minutes before anesthesia、after nasotracheal intubation、20 minutes before extubation）for dexmedetomidine on extubation stress and cognitive function after the laparoscopic cholecystectomy in the elderly patients undergoing sevoflurane anesthesia.Methods One-hundred cases of elderly patients undergoing elective laparoscopic cholecystectomy were randomly divided into four groups（n=25）：group D1、D2、D3 and C.All of the patients of group D1、D2、D3 received injection pump dexmedetomidine 0.4μg/kg（Guidance on the use of drug use and clinical application）respectively 20 minutes before anesthesia、after nasotracheal intubation、20 minutes before extubation within10 minutes.The patients of group C only received an injection pump of same amount of saline.Mean blood pressure（MAP）,heart rate（HR）,Riker sedation and agitation assessment（SAS）were evaluated at time points of before using drugs（T1）、spontaneous breathing recovery（T2）、extubating（T3）、5 minutes after extubation（T4）、15 minutes after extubation（T5）.The cognitive function of preoperative 1d、postoperative 1d、3d were evaluated by Montreal cognitive assessment scale（MoCA）,and to compare with the incidence rate of postoperative cognitive dysfunction,The concentration of serum insulin growth factor-1 was detected at time points of preoperative 1d、postoperative 1d、3d.Results There was no significant difference between the four groups in age,BIM,anesthesia time,education level,intraoperative transfusion volume and blood loss（P〉0.05）;Compared with the D1 group,there was no significant difference in HR,MAP,Riker sedation and agitation score（SAS）in D2 group（P〉0.05）,The HR,MAP,Riker sedation and agitation score（SAS）of D1 and D2 group were increased at the time point of T3~T5 but there was no significant difference（P〉0.05）.The HR and MAP had no significantly increase,and the Riker sedation and agitation score�

关 键 词：右美托咪定 全凭七氟醚麻醉 围拔管期 

分 类 号：R782.054[医药卫生—口腔医学]