预输注右美托咪定复合磷酸肌酸钠对老年食管癌根治术患者术后认知功能的影响  

Effects of dexmedetomidine and creatine phosphate sodium on postoperative delirium in elderly patients with radical resection of esophageal carcinoma

作　　者：仝彤[1] 刘向东[2] 吴振[1] 宋子贤[1] 刘华琴[1] TONG Tong;LIU Xiang-dong;WU Zhen;SONG Zi-xian;LIU Hua-qin(Department of Anesthesiology,the Fouth Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Vascular Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第四医院麻醉科,河北石家庄050011 [2]河北医科大学第三医院血管外科,河北石家庄050051

出　　处：《河北医科大学学报》2018年第12期1442-1446,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(20110130)

摘　　要：目的评价右美托咪定和磷酸肌酸钠对老年食管癌根治术术后认知功能的影响。方法将择期行食管癌根治术患者80例采用随机数字表法分为对照组(C组)、右美托咪定组(D组)、磷酸肌酸钠组(P组)、右美托咪定复合磷酸肌酸钠组(DP组)各20例。C组诱导前10min输注生理盐水20mL,D组诱导前10min输注相同容积的0.4μg/kg右美托咪定,P组诱导前10min输注相同容积的4.0g磷酸肌酸钠,DP组诱导前10min输注相同容积的0.4μg/kg右美托咪定和4.0g磷酸肌酸钠。4组分别于术前1d(T0)和术后24h(T3)进行简易智能状态检查量表(Mini-Mental State Examination,MMSE)评分;记录输注试验药物前(T1)、输注试验药物后(T2)的心率(heart rate,HR)、收缩压(systolic blood pressure,SBP),于T1和术后48h(T4)时间点抽取颈内静脉血样4mL测定血清S-100β蛋白浓度;比较各组T3和T4时间点的VAS评分。结果T1时点,4组HR、SBP差异均无统计学意义(P>0.05);T2时点,D组HR、BP均低于T1时点,D组HR、BP均低于C组、P组、DP组,差异有统计学意义(P<0.05)。T0时点,4组MMSE评分差异无统计学意义(P>0.05);T3时点,C组、D组和DP组MMSE评分均低于T0时点,D组、P组和DP组MMSE评分均高于C组,DP组MMSE评分高于P组,差异有统计学意义(P<0.05)。T0时点,4组血清S-100β蛋白浓度差异无统计学意义(P>0.05);T3时点,4组血清S-100β蛋白浓度均高于T0时点,D组、P组和DP组血清S-100β蛋白水平均低于C组,DP组血清S-100β蛋白水平低于D组和P组(P<0.05)。T3、T4时点,D组、DP组VAS评分均低于C组,差异有统计学意义(P<0.05)。结论单独预输注右美托咪定和磷酸肌酸钠均可降低老年食管癌根治术患者脑损伤程度并减轻术后谵妄,2种药物复合应用效果更加显著。Objective To investigate the effects of dexmedetomidine,creatine phosphate sodium and the combination of both on postoperative delirium in elderly patients with radical resection of esophageal carcinoma.Methods Eighty elderly patients who underwent selective esophageal carcinoma resection surgery were selected.All patients were divided into four groups randomly with the help of random number table.There were 20 individuals in each group.Patients in group C were given 20 mL NS within 10 minutes before induction of anesthesia;patients in group D were administered dexmedetomidine（0.4μg/kg）,group P sodium phosphocreatine（4.0 g）,and Group DP both of them at the same time within the same volume respectively.MiniMental State Examination（MMSE）scores were evaluated for every patient in all four groups on the day before surgery（T0）and 24 hafter surgery（T3）.Heart rate（HR）and systolic blood pressure（SBP）were recorded before the administration（T1）and after the administration（T2）.A4 ml of internal jugular vein blood sample was taken before infusion of the experimental drug（T1）and 48 hafter the surgery（T4）to determine the concentration of S-100βprotein.Visual Analogue Scale（VAS）scores were recorded at T3,T4 after surgery.Results At T1,there was not significant difference among all the four groups in HR and SBP（P〉0.05）.At T2,HR and BP of group D were lower than their counterparts at T1.At T2,HR and BP of group D were lower than their counterparts of group C,group P,and group DP,and the difference was significant（P〈0.05）.At T0,there was not significant difference in MMSE scores of four groups（P〉0.05）.At T3,MMSE of group C,group D,and group DP were lower,compared with the MMSE scores at T0.MMSE scores of group C,group D,and group DP were significant higher than that of group C,and moreover,MMSE scores of group DP was higher than that of group P,which were all significant with（P〈0.05）.At T0,there was not significant difference among four groups on S-100βconc

关 键 词：食管肿瘤 认知 右美托咪定 磷酸肌酸 

分 类 号：R735.1[医药卫生—肿瘤]