右美托咪定在帕金森患者行脑深部刺激器植入术中的应用  

Application of dexmedetomidine in deep brain stimulation implantation of patients with Parkinson’s disease

作　　者：梅凤美[1] 曾琼[1] 吴姗姗[1] 金晶星[1] 

机构地区：[1]南京脑科医院麻醉科,江苏省210029

出　　处：《江苏医药》2017年第24期1776-1778,共3页Jiangsu Medical Journal

摘　　要：目的观察右美托咪定在帕金森患者行脑深部刺激器植入术(DBSI)中的应用效果。方法行DBSI帕金森患者60例,随机均分两组。D组手术开始前15min内静脉泵注右美托咪定0.5μg/kg,随后0.3μg·kg^(-1)·h^(-1)维持输注;C组输注等量生理盐水作为对照。记录术前和术中MAP、HR、Narcotrend指数(NTI)和Ramsay镇静评分变化,评估术后早期老年谵妄测验(CAM-CR)评分和简易精神状态评分(MMSE)。结果与C组比较,D组术中MAP较低,HR较慢,NTI下降,Ramsay镇静评分升高(P<0.05)。两组术后72h内的CAM-CR评分均高于术前(P<0.05),D组评分低于C组(P<0.05)。两组术后7d内,尤其是术后第1天,MMSE评分低于术前(P<0.05)。D组患者术后谵妄发生率3.3%(1/30),低于C组的26.7%(8/30)(P<0.05)。结论右美托咪定应用于帕金森患者DBSI具有良好的镇静效果,可以减少术后谵妄的发生,且不加重术后认知功能障碍。Objective To observe the outcomes of dexmedetomidine administration in deep brain stimulation implantation（DBSI）of patients with Parkinson’s disease（PD）.Methods DBSI was performed in 60 patients with PD,who were randomly assigned into two groups with 30 cases each.The patients in group D were infused dexmedetomidine 0.5μg/kg in 15 minutes before operation,which was followed by infusion of dexmedetomidine 0.3μg·kg^（-1）·h^（-1） during surgery.The patients in group C were given equal volume of normal saline instead of dexmedetomidine as the controls.The changes of MAP,HR,Narcotrend index（NTI）and Ramsay sedation score were recorded before and during operation.The scores of confusion assessment method-Chinese reversion（CAM-CR）and minimental sate examination（MMSE）were evaluated in the early postoperative period.Results Compared to group C,group D had lower MAP,HR and NTI and higher Ramsay sedation score during operation（P〈0.05）.CAM-CR scores within postoperative 72 hours were higher than those before operation（P〈0.05）,which were lower in group D than those in group C（P〈0.05）.MMSE scores were lower in 7 days after operation,especially on the 1 st day,than those before operation（P〈0.05）.The incidence of postoperative delirium was 3.3%（1/30）,which was lower than 26.7%（8/30）in group C（P〈0.05）.Conclusion Dexmedetomidine administration in DBSI of patients with PD has a good sedation and may reduce the occurrence of postoperative delirium without increasing postoperative cognitive dysfunction.

关 键 词：右美托咪定 帕金森病 脑深部刺激器 谵妄 认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]