右美托咪定对微血管减压患者术后苏醒质量及早期认知功能的影响  

Effect of Dexmedetomidine on postoperative recovery quality and early cognitive function in patients with microvascular decompression

作　　者：蔡伯涛 唐吉伟[2] 李勇[2] 张柏银[2] CAI Bo-tao;TANG Ji-wei;LI Yong;ZHANG Bai-yin(College of Clinical Medicine,Hu'nan University of Chinese Medicine,Hu'nan Province,Changsha 410007,China;Department of Anesthesiology and Surgery,Brain Hospital of Hu'nan Province,Changsha 410007,China)

机构地区：[1]湖南中医药大学临床医学院,湖南长沙410007 [2]湖南省脑科医院麻醉手术科,湖南长沙410007

出　　处：《中国当代医药》2019年第17期4-8,共5页China Modern Medicine

基　　金：湖南省卫生计生委科研计划课题横向项目(B2016028)

摘　　要：目的观察右美托咪定对微血管减压患者术后苏醒质量及早期认知功能的影响。方法选取2017年1月~2018年6月在我院行择期微血管减压术的60例患者作为研究对象,采用随机数字表法将其分为右美托咪定组(D组)和对照组(C组),每组各30例。D组麻醉诱导前予以右美托咪定,C组用同样方法注射生理盐水。比较两组患者的术中一般情况(手术时间、出血量、尿量、晶体及胶体输注量);观察两组患者入室静卧5 min(T1)、麻醉诱导插管时(T2)、手术切皮时(T3)、钻颅骨时(T4)、血管减压时(T5)、手术结束时(T6)的血流动力学指标(收缩压、心率);并记录患者术后呼吸恢复时间、苏醒时间、拔管时间及拔管期间的呛咳评分和躁动评分;测定术前1 d(t1)、手术完毕(t2)、术后24 h(t3)患者血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及血浆皮质醇(COR)的水平;并于t1和术后3 d采用韦氏成人智力量表(WAIS)、韦氏记忆量表(WMS)及简易智能精神状态检查量表(MMSE)行神经精神功能测试评价认知功能;比较两组患者的术后认知功能障碍(POCD)发生率。结果两组患者的手术时间、出血量、尿量、晶体及胶体输注量比较,差异无统计学意义(P>0.05)。D组患者T2、T4、T5的收缩压均明显低于C组,T2、T4的心率均明显低于C组,差异有统计学意义(P<0.05)。两组患者的呼吸恢复时间、苏醒时间及拔管时间比较,差异无统计学意义(P>0.05)。D组患者拔管期间呛咳和躁动情况均优于C组,差异有统计学意义(P<0.05)。两组患者t1的血清IL-6、TNF-α、COR水平比较,差异无统计学意义(P>0.05);两组患者t2、t3的血清IL-6、TNF-α、COR水平均高于t1,差异有统计学意义(P<0.05);D组患者t2、t3的血清IL-6、TNF-α、COR水平均明显低于C组,差异有统计学意义(P<0.05)。D组患者术后3 d的MMSE、视觉再生、词语联想评分均明显高于C组,数字符号时间、连线实验�Objective To investigate the effect of Dexmedetomidine on postoperative recovery quality and early cognitive function in patients with microvascular decompression. Methods Sixty patients who underwent elective microvascular decompression in our hospital from January 2017 to June 2018 were enrolled in the study. They were divided into Dexmedetomidine group (group D) and control group (group C) according to the random number table method, 30 cases in each group. The group D was given Dexmedetomidine before induction of anesthesia, and the group C was injected with normal saline by the same method. The general conditions of surgery (operation time, blood loss, urine volume, infusion volume of crystal and colloidal) were compared between the two groups. The hemodynamic parameters (systolic blood pressure, heart rate) were observed in the two groups at the following points, such as resting into the room for 5 min (T1), anesthesia-induced intubation (T2), surgical incision (T3), drilling of the skull (T4), vascular decompression (T5), and end of operation (T6). The postoperative respiratory recovery time, waking time, extubation time and coughing score and agitation score during extubation were recorded in the two groups. The serum levels of interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and plasma cortisol (COR) were measured at 1 day before operation (t1), at the completion of operation (t2) and 24 hours after operation (t3). The neurological function test by Wechsler adult intelligence scale (WAIS), Wechsler memory scale (WMS) and mini-mental state examination (MMSE) was performed to evaluate the cognitive function at t1 and 3 days after operation. The incidence rate of postoperative cognitive dysfunction (POCD) was compared between the two groups. Results There were no significant differences in the operation time, blood loss, urine volume, crystal and colloidal infusion volume between the two groups (P>0.05). The systolic blood pressure at T2, T4 and T5 in the group D was significantly lower than that in g

关 键 词：右美托咪定 微血管减压术 苏醒质量 认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]