不同剂量右美托咪定对心血管手术患者术后认知功能障碍及炎性反应介质的影响  

Different doses of dexmedetomidine on the patients with cognitive dysfunction and inflammatory mediators after cardiovascular surgery

作　　者：潘传龙 陈静霞 刘志恒[1] PAN Chuan-long;CHEN Jing-xia;LIU Zhi-heng(Department of anesthesiology,The Second People′s Hospital of Shenzhen,Shenzhen 518035,China)

机构地区：[1]深圳市第二人民医院麻醉科,广东深圳518035

出　　处：《吉林医学》2019年第2期261-263,共3页Jilin Medical Journal

摘　　要：目的:探讨不同剂量右美托咪定对心血管手术患者术后认知功能障碍(POCD)及炎性反应介质的影响。方法:将120例心血管手术麻醉患者随机分为低剂量组和高剂量组,每组60例。低剂量组患者给予0. 5μg/(kg·h)持续泵注右美托咪定,高剂量组患者给予0. 8μg/(kg·h)持续泵注右美托咪定。比较两组患者手术前后简易治理状态检查法(MMSE)评分、苏醒时间、自主呼吸时间、拔管时间及炎性反应介质变化。结果:术后1 d低剂量组MMSE评分显著高于高剂量组患者(t=2. 918,P <0. 01)。低剂量组患者苏醒时间、自主呼吸时间、拔管时间均显著低于高剂量组患者,差异有统计学意义(t=6. 548,t=4. 819,t=7. 052,P <0. 01)。两组患者炎性反应因子水平比较,差异无统计学意义(P> 0. 05)。结论:通过观察不同剂量右美托咪定的应用对体外循环下心血管手术患者POCD和炎性反应介质的影响,寻求更有效的预防、治疗和改善POCD预后的方法,减少因POCD导致的康复延迟、并发症增多、住院天数延长和医疗费用增加等问题。0. 5μg/(kg·h)持续泵注右美托咪定在心血管手术中应用效果良好,控制应激反应的同时能够减轻术后认知功能障碍,具有临床应用价值。Objective To investigate the dose effect of dexmedetomidine on cognitive dysfunction and inflammatory mediators in patients undergoing cardiovascular surgery.Method 120 patients with cardiovascular surgery were randomly divided into low dose group(n=60)and high dose group(n=60).The low dose group were treated with 0.5μg/(kg·h)continuous infusion of dexmedetomidine,the high dose group was treated with 0.8μg/(kg·h)continuous infusion of dexmedetomidine.Comparison of the two groups of patients before and after the operation of the simple management state examination(MMSE)score,recovery time,spontaneous breathing time,extubation time and inflammatory mediators.Results The MMSE score of 1 day low dose group was significantly higher than that of high dose group(t 2.918,P 0.01).The recovery time,spontaneous breathing time,extubation time in the low dose group were significantly lower than those in the high dose group(t=6.548,t=4.819,t=7.052,P<0.01).There was no significant difference in the level of inflammatory factors between the two groups(P >0.05).Conclusion By observing the effects of application of different doses of dexmedetomidine on cardiopulmonary bypass cardiac surgery in patients with POCD and inflammatory mediators,to seek more effective methods to prevent and treatment and improve the prognosis of POCD,reduce the problem of delay,caused by POCD in the rehabilitation of increased complications,hospitalization days and prolonged increase of medical cost.0.5μg/(kg·h)continuous infusion of dexmedetomidine in cardiovascular surgery with good results,at the same time to control the stress response can reduce postoperative cognitive dysfunction,has clinical application value.

关 键 词：心血管手术 右美托咪定 认知障碍 剂量 

分 类 号：R614[医药卫生—麻醉学]