观察右美托咪定对老年患者开胸手术术后认知功能的影响  

Effect of thoracotine on intravenous oxygen metabolism and cognitive function in aged surgery patients

作　　者：夏良勇[1] 程思[1] 卢强[1] 马祥[1] 吴超[1] 孙昊[1] 李蕾[1] 董春山[1] 

机构地区：[1]合肥市第一人民医院麻醉科,安徽合肥230061

出　　处：《临床肺科杂志》2017年第9期1614-1616,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的本研究右美托咪定静脉麻醉下开胸手术对老年患者大脑氧代谢及认知功能的影响。方法择期全麻下行开胸手术患者82例,采用随机数字表法,将其随机分为2组。其中对照组(41例)实施麻醉诱导前泵注生理盐水15m I,观察组(41例)右美托咪啶负荷剂量0.5μg/kg(用生理盐水稀释至15 m L,30min内静脉持续泵注),然后以0.25-0.4μg·kg^(-1)·h^(-1))的速度持续静脉输注至手术结束前40分钟。两组麻醉常规诱导行双腔支气管插管机械通气。观察两组手术时间、自主呼吸恢复时间、苏醒时间,拔管后即刻、以及拔管后1、3和24小时认知功能的评价。结果两组患者手术苏醒情况近似。观察组的动脉氧分压高于对照组,P<0.05;二组二氧化碳分压水平未见显著差异;研究中使用MMSE评价两组患者术后的认知功能状态,结果提示拔管后即刻以及拔管后1小时观察组的MMSE评分均高于对照组,P<0.05;两组患者在拔管后即刻MMSE评分分别为29.19±0.88和25.84±0.61;拔管后1小时的评分为29.07±0.74和23.75±0.47。而拔管后3小时和24小时,两组患者的MMSE评分水平均为27-29水平左右,且未见差异。结论右美托咪啶对于开胸手术的老年患者具有改善术后认知功能的效力。Objective To investigate the effect of thoracotomy on brain's oxygen metabolism and cognitive function in elderly patients with dexmedetomidine intravenous anesthesia. Methods 82 patients undergoing elective general anesthesia for thoracic surgery were randomly divided into 2 groups. The control group was given infusion of saline 15 m L before the induction of anesthesia,and the observation group was given 0. 5? g/kg( diluted with saline to 15 m L 30 min intravenous continuous infusion,then in 0. 25-0. 4 g·kg^(-1)·h^(-1)) speed continuous intravenous injection to the end of 40 minutes before surgery. All patients were given routine anesthesia and mechanical ventilation. The operative time,spontaneous breathing recovery time,recovery time,extubation time and 1,3,and 24 hours after extubation were observed and evaluated between the two groups. Results The operation and the recovery of the observation group and the control group were similar. The arterial oxygen partial pressure of the observation group was higher than that of the control group( P < 0. 05). The partial pressure of carbon dioxide showed no significant difference. MMSE was used to evaluate the postoperative functional status of the two groups. The MMSE scores of the two groups were 29. 19 ± 0. 88 and 25. 84 ± 0. 61 respectively after extubation. The score of 1 hour after extubation was 29. 07 ± 0. 74 and 23. 75 ± 0. 47( P < 0. 05),and the MMSE scores of the two groups were significantly higher than those of the control group. 3 and 24 hours after extubation,the MMSE scores of the two groups were about 27-29,and no difference was found. Conclusion Dexmedetomidine can effectively improve cognitive function in elderly patients undergoing thoracic surgery.

关 键 词：右美托咪啶 开胸手术 老年 大脑氧代谢 认知功能 

分 类 号：R614[医药卫生—麻醉学]