右美托咪定对全麻老年患者术后血浆1-抗糜蛋白酶表达的影响  

Effect of Dexmedetomidine on the Postoperative Expression of Plasma 1-Antichymotrypsin in Senile Patients with General Anesthesia

作　　者：李丽萌[1] 陈彦青[1] 吴晓丹[1] 廖燕凌[1] 邱良诚[1,2] 

机构地区：[1]福建医科大学省立临床学院麻醉教研室,福建福州350001 [2]福建省立金山医院麻醉科,福建福州350028

出　　处：《中外医疗》2017年第27期16-19,共4页China & Foreign Medical Treatment

基　　金：福建省卫生计生青年科研课题(2016-1-28)

摘　　要：目的评价右美托咪定对全麻老年患者术后血浆1-抗糜蛋白酶表达的影响。方法方便选取择期全麻患者60例(福建省立医院,2015年2月—2017年2月),ASA分级Ⅱ或Ⅲ级,年龄65~79岁,体重45~72 kg,采用随机数字表法,随机分为两组(n=30):右美托咪定组(D组)和对照组(C组)。D组麻醉诱导前静脉输注右美托咪定负荷量0.5 g/kg,输注时间15 min,然后以0.5 g/(kg·h)的速率静脉输注至术毕,C组予等容量生理盐水输注。分别于术前1 d(T0)和手术结束后1 d(T_1)、3 d(T_2)、7 d(T_3)时采血检测1-抗糜蛋白酶浓度,并于上述时点采用简易智能量表(MMSE)对患者进行认知功能测试,记录POCD的发生情况。结果 D组POCD发生率为4例(14%),明显低于C组的9例(33%)(P<0.05);T_1~3时,两组POCD患者血浆α1-ACT浓度[D组(T_1(477±47)μg/mL,T_2(356±29)μg/mL,T_3(317±27)μg/mL;C组T_1(601±57)μg/mL,T_2(473±42)μg/mL,T_3(360±29)μg/mL明显高于相应组非POCD患者[D组T_1(286±39)μg/mL,T_2(230±38)μg/mL,T_3(236±41)μg/mL;C组T_1(537±41)μg/mL,T_2(386±54)μg/mL,T_3(229±33)μg/mL(P<0.05),同时D组POCD患者血浆α1-ACT浓度[D组T_1(477±47)μg/mL,T_2(356±29)μg/mL,T_3(317±27)μg/mL]较C组POCD患者[C组T_1(601±57)μg/mL,T_2(473±42)μg/mL,T_3(360±29)μg/mL]明显降低(P<0.05)。结论右美托咪定可以抑制全麻老年患者术后血浆1-抗糜蛋白酶的过度表达。Objective To evaluation the effect of dexmedetomidine on the postoperative expression of plasma 1-antichymotrypsin in senile patients with general anesthesia. Methods 60 cases of general anesthesia patients in the Fujian Provincial Hospital from February 2015 to February 2017 whose ASA classification was Ⅱ or Ⅲ and whose age was 65~79 years old and whose weight was 45~72 kg were convenient selected and randomly divided into two groups with 30 cases in each,the dexmedetomidine group（group D） adopted the venous infusion of dexmedetomidine load capacity of 0.5 g/kg, and the infusion time was 15 min at a rate of 0.5 g/（kg·h） to the end of operation, while the control group（group C） adopted the infusion of capacity of normal saline gavage, and the concentration of plasma 1-antichymotrypsin was tested by blood collection before operation 1 d（T0） and at the end of operation 1 d（T1）, 3 d（T2）, 7 d（T3）, and the cognitive function of patients was tested by the MMSE at the above time points and the occurrence of POCD was recorded. Results The incidence rate of POCD in the group D was obviously lower than that in the group C,（14% vs 33%, 4 cases vs 9 cases）（P〈0.05）, and the plasmaα1-ACT concentration of POCD patients were obviously higher than those of non-POCD patients,[the group D T1（477±47）μg/mL,T2（356±29）μg/mL, T3（317±27）μg/mL; the group C T1（601±57）μg/mL,T2（473±42）μg/mL, T3（360±29）μg/mL] vs [the group D T1（286±39）μg/mL,T2（230±38）μg/mL,T3（236 ±41）μg/mL, the group C T1（537±41）μg/mL,T2（386±54）μg/mL,T3（229 ±33）μg/mL]（P〈0.05）, at the same time,the plasma α1-ACT concentration of POCD patients in the group D obviously decreased compared with that in the group C,[the group D T1（477±47）μg/mL,T2（356±29）μg/mL, T3（317±27）μg/mL vs the group C T1（601±57）,T2（473±42）μg/mL, T3（360±29）μg/mL]（P〈0.05）. Conclusion Dexmedetomidine can inhibit the over-expression of plasma 1-antichy

关 键 词：右美托咪定 老年患者 认知功能 1-抗糜蛋白酶 

分 类 号：R614[医药卫生—麻醉学]