右美托咪定配伍依托咪酯对全麻的老年患者术后认知功能障碍的影响  

The effect of dexmedetomidine combined with etomidate on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia

作　　者：李琳[1] 杨旭芳[2] 芦相玉[1] 韩继成[1] 

机构地区：[1]牡丹江医学院红旗医院麻醉科,黑龙江157011 [2]牡丹江医学院病理生理教研室,黑龙江157011

出　　处：《齐齐哈尔医学院学报》2017年第11期1252-1255,共4页Journal of Qiqihar Medical University

基　　金：牡丹江医学院2014年度研究生创新科研资金项目(2014YJSCX-16);牡丹江医学院科学技术研究项目(ZSSD210605)

摘　　要：目的探究右美托咪定配伍依托咪酯对全麻的老年患者术后认知功能障碍的影响。方法选择90例ASAⅠ~Ⅱ级年龄在65~75岁之间的全麻腹部手术患者,体重48~75 kg,随机将90例患者分为三组(n=30):右美托咪定组(D组)、依托咪酯组(E组)和右美托咪定配伍依托咪酯组(DE组)。均采用静吸复合麻醉,术中麻醉用药相同。D组:麻醉诱导给予1μg/kg右美托咪定(10min静注完毕);E组:麻醉诱导给予0.20 mg/kg的依托咪酯静注,DE组:麻醉诱导静注0.20 mg/kg依托咪酯和1μg/kg右美托咪定(10min钟静注完毕)。记录术前1天(T_0)、手术开始前(T_1)、手术结束(T_2)、麻醉停止后患者意识恢复的时间(T_3),拔管前即刻(T_4)、拔管后即刻(T_5)、拔管后3 min(T_6)、5 min(T_7)的HR、MAP和Sp O_2。于术前(T_0)、术后1天、3天抽取静脉血样,采用酶联免疫测定IL-Aβ41、IL-6炎症因子的水平,并采用MMSE于三个时点测认知状态。结果与E组相比,DE组和D组IL-6水平降低(P<0.05),与术前相比,E组术后1、3天IL-6水平升高(P<0.05)。血压比较,给予右美托咪定的两组术中平均动脉压心率偏低(P<0.05),但D组血压波动较大。并且与E组相比,DE组术后POCD的发生率显著降低(P<0.05),与E组相比,DE组与D组MMSE评分显著降低(P<0.05),三组间IL-Aβ41及自主呼吸恢复时间、唤醒时间、清醒拔管时间无显著差异(P>0.05)。结论右美托咪定复合依托咪酯使患者围术期血压稳定,降低术后炎症因子水平,减少其术后认知功能障碍的发生。Objective To investigate the effect of dexmedetomidine combined with etomidate on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia.Methods 90 patients（aged from 65 to 75 years old,48 to 75 kg in weight,ASA grading Ⅰ or Ⅱ） received abdominal surgery under general anesthesia,were divided into three groups,30 patients in each group： dexmedetomidine group（group D）,etomidate group（group E） and dexmedetomidine combined with etomidate group（group DE）. All the patients received anesthesia by using intravenous process and the intraoperative anesthetic medication were the same.Group D： 1μg/kg dexmedetomidine was given in the induction period（complete intravenous injection within 10 minutes）,E group： given 0.20mg/kg etomidate during induction period,DE group： 0. 20mg/kg etomidate and1μg/kg dexmedetomidine（finished intravenous injection in 10 min）. Recording the HR,MAP and SpO 2at the time points one day before operation（T_0）,before surgery（T_1）,end of surgery（T_2）,the time to recovery of consciousness after anesthesia was stopped（T_3）,immediately before extubation（T_4）,immediately after extubation（T_5）,three minutes after extubation（T_6）,five minutes（T_7）. Collecting blood sample at the three time points： preoperative（T_0）,one day,three days after the surgery. The levels of IL-Aβ41 and IL-6 were measured by enzyme-linked immunosorbent assay（ELISA）.Using MMSE to determine the cognitive score at three time points. Results Compared with group E,the levels of IL-6 in group D and group DE were lower than those in group E（P〈0.05）. The levels of IL-6 in group E were significantly higher than those before operation（P〈0.05）. The heart rate and blood pressure was lower in patients receiving dexmedetomidine（P〈 0. 05）. Compared with group E,the incidence of postoperative POCD was significantly lower in DE group and D group（P〈0.05）,and the MMSE score in E group was significantly lower than that in

关 键 词：右美托咪定 依托咪酯 老年患者 术后认知功能障碍 炎症 

分 类 号：R749[医药卫生—神经病学与精神病学]