右美托咪定复合麻醉对贫血患者术后认知功能的影响  

Effects of dexmedetomidine-based anesthesia on postoperative cognitive function in patients with anemia

作　　者：黄昕 白文娅[2] 杨延超 滕秀飞[2] 朱俊超 HUANG Xin;BAI Wen-ya;YANG Yan-chao(Union Hospital Affiliated to Tongji Medical college of Huazhong Uni-versity of Science and Technology,Department of Anesthesiology,Wuhan 430022,China;Shengj ing Hospital of China Medical University,Department of Anesthesiology,Shenyang 110004,China)

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,湖北武汉430022 [2]中国医科大学附属盛京医院麻醉科,辽宁沈阳110004

出　　处：《中国实验诊断学》2018年第8期1306-1309,共4页Chinese Journal of Laboratory Diagnosis

基　　金：辽宁省自然科学基金(20102282)资助

摘　　要：目的探讨麻醉因素(右美托咪定复合麻醉)与贫血患者妇科开腹术后认知功能障碍的关系。方法择期妇科开腹术患者40例,血红蛋白80-90g/L,年龄50-70岁,体重50-80kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=20):常规麻醉组(N组),右美托咪定复合麻醉组(D组)。两组均采用常规麻醉诱导以及常规七氟醚和瑞芬太尼静吸复合全身麻醉维持。D组在麻醉诱导前经10min静脉输注右美托咪定0.5μg/kg,继之以0.5μg·kg-1·h-1的速率输注至手术结束前的40 min,N组给予等容量0.9%生理盐水。采用长沙版蒙特利尔认知评估量表(MoCA)评估术前1d、术后3d以及术后7dPOCD的发生情况,记录MoCA评分以及两组术后7d内POCD的发生率。结果两组术前1dMoCA评分差异无统计学意义(P>0.05)。与N组比较,D组术后3d,术后7dMoCA评分升高,且D组术后7d内POCD的发生率降低(3.0%vs.22%,P<0.05)。结论麻醉因素与贫血患者妇科开腹术后认知功能障碍的发生率有关。右美托咪定复合麻醉能够降低贫血患者术后认知功能障碍的发生。Objective To investigate the relationship between anesthetic factor and postoperative cognitive function in patients with anemia undergoing gynecological surgery.Methods Forty female patients,with hemoglobin concentration of 80-90 g/L,aged 50-70 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective gynecologic operation were randomly divided into 2 groups（n=20）using a random number table：Normal anesthesia group（group N）and dexmedetomidine-based anesthesia group（group D）.Routinely after anesthesia induction sevoflurane-remifentanil combined intravenous-inhalational anesthesia was performed.Dexmedetomidine was infused intranenously at a dose of 0.5μg/kg over 10 min,before induction of anesthesia,followed by 0.5μg·kg-1·h-1 infusion until 40 min prior to the end of surgery.An equal volume of normal saline was given in group C instead.Postoperative cognitive dysfunction was assessed at the 1 st day before the start of the operation,at the 3 rd day,and at the7 th day after the operation using Montreal Cognitive Assessment（MoCA）,the score of MoCA,as well as the incidence of POCD 7 days after operation were also recorded.Results At the 1 st before the start of the operation,the score of MoCA was not significantly different between the two groups.Compared with group N,the score of MoCA was higher,and the incidence of POCD was lower in group D（P〈0.05）,Furthermore,the incidence of POCD 7 days after the operation was lower in the group D（3.0% vs.22%,P〈0.05）.Conclusion Anesthetic factors are related to postoperative cognitive function in patients with anemia undergoing gynecological surgery.Dexmedetomidine-based anesthesia can decrease the incidence of POCD in patients with anemia.

关 键 词：全身麻醉 右美托咪啶 术后认知功能障碍 贫血 妇科开腹术 

分 类 号：R614.2[医药卫生—麻醉学]