右美托咪定在防治老年患者术后认知功能障碍中的应用价值  

Effects of dexmedetomidine on the prevention and treatment of postoperative cognitive dysfunction in elderly patients

作　　者：魏晓[1] 田毅[1] 王颖林 黄运伯[1] 田国刚 Wei Xiao;Tian Yi;Wang Yinglin;Huang Yunbai;Tian Guogang(Department of Anesthesiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, China;Department of Anesthesiology, Donjang Hospital, Shanghai 200120, China;Department of Anesthesialogy, Sanya Municipal Hospital, Sanya 572000, China)

机构地区：[1]中南大学湘雅医学院附属海口医院海口市人民医院麻醉科,570208 [2]上海市东方医院麻醉科,200120 [3]三亚市人民医院麻醉科,572000

出　　处：《国际麻醉学与复苏杂志》2018年第5期414-417,共4页International Journal of Anesthesiology and Resuscitation

基　　金：海南省自然科学基金（812167）;海南省卫生厅项目（琼卫2013自筹-43）

摘　　要：目的 探讨右美托咪定（dexmedetomidine, Dex）防治老年患者术后认知功能障碍（postoperative cognitive dysfunction, POCD）的应用价值。 方法 选择年龄≥65岁、ASA分级Ⅱ、Ⅲ级、符合简易精神状态评价量表（mini-mental state examination, MMSE）筛选标准的行择期胃肠道手术患者65例，采用随机数字表法分为对照组（C组，33例）和Dex组（D组，32例）。D组手术前以1 μg·kg-1·h-1恒速泵注Dex 10 min，C组手术前按照同等速度输注0.9%氯化钠溶液10 min。常规麻醉诱导及静脉麻醉维持，维持BIS值45~65，记录患者一般情况，瑞芬太尼和异丙酚用量，Dex给药前（T0）、给药后10 min（T1）、给药后20 min（T2）及术毕（T3）的血流动力学变化。根据神经心理学测试结果评定POCD。 结果 D组瑞芬太尼和异丙酚用量较C组明显减少（P＜0.05）；C组患者在T1时点HR、SBP和DBP高于T0（P＜0.05），D组患者在T2时点HR、SBP和DBP低于T0（P＜0.05），D组患者在T1和T2时点HR、SBP和DBP均低于C组（P＜0.05）；C组POCD发生率为30.3%（10/33），D组POCD发生率为6.3%（2/32），较C组明显降低，差异有统计学意义（P＜0.05）。 结论 Dex可有效维持血流动力学稳定，减少瑞芬太尼和异丙酚用量，降低老年患者术后POCD发生率。Objective To evaluate the effect of dexmedetomidine （Dex） on the prevention and treatment of postoperative cognitive dysfunction （POCD） in elderly patients. Methods The study includes patients （≥ 65 years） classified as ASA class Ⅱ or Ⅲ who underwent elective gastrointestinal surgery. All enrolled patients were randomly divided into control group （group C, n=33） and Dex group （group D, n=32）. The group D and group C were respectively given 1 μg·kg-1·h-1 Dex and 0.9% NaCl 10 min before surgery. All patients received intravenous anesthesia to maintain the BIS value between 45 and 65. Recored the general condition of the patient, the dosage of remifentanil and propofol and hemodynamic changes before Injection of Dex（T0）, 10 min after administration （T1）, 20 min after administration（T2） and at the end of surgery（T3）. POCD was evaluated with the neuropsychological testing. Results Total doses of remifentanil and propofol in group D were significantly reduced in comparison with group C（P〈0.05）. HR, SBP, and DBP at T1 were higher than T0 in group C （P〈0.05）, while HR, SBP, and DBP at T2 were lower than T0 in group D（P〈0.05）. HR, SBP and DBP in group D were lower than group C at T1 and T2（P〈0.05）. The incidence of POCD in group C was 30.3%（10/33）, significantly higher than that in group D（6.3%, 2/32, P〈0.05）. Conclusions Dex can reduce total doses of remifentanil for anesthesia and the incidence of POCD during elective gastrointestinal surgery, and stabilize hemodynamics.

关 键 词：右美托咪定 老年人 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]