右美托咪啶对无线镇痛管理的老年胸腔镜患者术后认知功能的影响  

Effect of Dexmedetomidine on postoperative impairment of cognitive function in elderly patients undergoing thoracoscopic surgery under wireless analgesia

作　　者：吴城[1] 杜建龙 江能[1] 路建[1] 周红梅[1] Wu Cheng;Du Jianlong;Jiang Neng;Lu Jian;Zhou Hongmei(Department of Anesthesiology , the Second Affiliated Hospital of Jiaxing University , Jiaxing 314000, China;Department of Anesthesiology , the First People Hospital of Tongxiang ,Tongxiang 314500 China)

机构地区：[1]嘉兴学院附属第二医院麻醉手术科,嘉兴314000 [2]桐乡市第一人民医院麻醉科,桐乡314500

出　　处：《中华老年医学杂志》2019年第4期400-403,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨右美托咪啶对无线镇痛管理的老年胸腔镜患者术后认知功能的影响。 方法选取2017年5月至2018年4月我院行胸腔镜手术的80例老年患者,按照随机数字法将其分为S组(40例)和DS组(40例),S组无线镇痛中予以舒芬太尼,DS组在此基础上加用右美托咪啶,并比较不同组患者术前术后简易精神量表(MMSE)评分、术后疼痛程度、外周血IL-1、IL-6和TNF-α表达水平以及不良反应。 结果MMSE评分DS组患者术后1d[(26.85±1.20)分和(26.33±1.33)分,t=1.795,P=0.038]和3d[(26.65±1.16)分和(26.00±1.29)分,t=2.370,P=0.010]高于S组;疼痛VAS评分DS组患者术后6h[(4.32±0.64)分和(4.65±0.77)分,t=2.138,P=0.018]和12h[(4.01±0.45)分和(4.23±0.59)分,t=1.875,P=0.032]低于S组;术前当天、术后5和7d,两组患者白细胞介素1(IL-1)、白细胞介素6(IL-)6和肿瘤坏死因子α(TNF-α)表达水平差异不显著(P>0.05),术后1和3d其IL-1、IL-6和TNF-α表达水平比较差异显著(P<0.05);DS组患者恶心发生率低于S组(2.5%和15.0%,χ^2=3.914,P=0.048),而心动过缓发生率则高于S组(17.5%和2.5%,χ^2=5.000,P=0.025)。 结论右美托咪啶不仅能有效改善无线镇痛管理下老年胸腔镜患者术后疼痛程度和认知功能,同时还能降低术后炎性水平。Objective To investigate the effect of Dexmedetomidine on postoperative impairment of cognitive function in elderly patients undergoing thoracoscopic surgery under wireless analgesia. Methods Eighty elderly patients undergoing thoracoscopic surgery in our hospital from May 2017 to April 2018 were randomly divided into the S group(n=40)receiving Sufentanil under wireless analgesia, and the DS group receiving Dexmedetomidine as add-on to the therapy for S group.The mini-mental state examination(MMSE)score, postoperative pain degree, and serum levels of interleukin(IL)-1, IL-6 and tumor necrosis factor(TNF)-α, as well as adverse reactions were compared between the two groups, preoperatively and postoperatively. Results MMSE score was higher in the DS group than in the S group at 1 and 3 days after operation[(26.85±1.20)vs.(26.33±1.33),(26.65±1.16)vs.(26.00±1.29), t=1.795 and 2.370, P=0.038 and 0.010]. Pain visual analog scale(VAS)score was lower in the DS group than in the S group at 6 and 12 hours after operation[(4.32±0.64)vs.(4.65±0.77),(4.01±0.45)vs.(4.23±0.59), t=2.138 and 1.875, P=0.018 and 0.032, respectively]. At 1 and 3 days after operation, IL-1, IL-6 and TNF-α levels were higher in SD group than in S group(P<0.05). But, at 5 and 7 days after operation, there was no significant difference in the expression levels of IL-1, IL-6 and TNF between the two groups(P>0.05). The incidence of nausea was lower in DS group than in S group(2.5% vs.15.0%,χ^2=3.914, P=0.048), while the incidence of bradycardia was higher in the DS group than in the S group(17.5% vs.2.5%,χ^2=5.000, P=0.025). Conclusions Dexmedetomidine not only effectively alleviates the postoperative pain and improves cognitive function in elderly patients undergoing thoracoscopic management under wireless analgesia, but also reduces postoperative inflammatory levels.

关 键 词：胸腔镜 镇痛 右美托咪咤 认知 

分 类 号：R614[医药卫生—麻醉学]