右美托咪定对老年椎弓根内固定患者术后认知功能的影响  

Effect of dexmedetomidine on the postoperative cognitive function in elderly patients undergoing pedicle internal fixation under general anesthesia

作　　者：钱利军[1] 魏磊[1] 吴学东[1] 赵建华[1] 谢阳 QIAN Lijun;WEI Lei;WU Xuedong;ZHAO Jianhua;XIE Yang(Department of Anesthesiology,Suzhou Affiliated Hospital,Nanjing Medical University,Suzhou 215002)

机构地区：[1]南京医科大学附属苏州医院本部麻醉科

出　　处：《南通大学学报（医学版）》2019年第3期188-191,共4页Journal of Nantong University(Medical sciences)

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX201608)

摘　　要：目的:评价右美托咪定镇静对老年椎弓根内固定术患者术后认知功能的影响。方法:选择择期椎弓根内固定术老年患者60例,性别不限,年龄65~83岁,ASAⅡ~Ⅲ级,采用随机数字表法将患者分为对照组(C组)和右美托咪定组(Dex组),各30例。Dex组麻醉诱导前30 min静脉泵注负荷剂量右美托咪定0.5μg·kg^-1,输注时间10 min,随后持续静脉泵注右美托咪定0.2μg·kg-1·h^-1至术毕;C组患者术中采用同样方法输入等量的生理盐水。于T0(麻醉给药前)、T1(术毕)、T2(术后24 h)时分别采集外周动脉血及颈静脉球部血液各2 mL,计算脑动脉-静脉血氧含量差(arterio-venous oxygen content difference,Da-jvO2)和脑氧摄取率(cerebral oxygen extraction rate, CERO2),并检测S100β蛋白及神经元特异性烯醇化酶(neuron specific endase, NSE)浓度的变化。结果:与T0相比,两组患者T1时血Da-jvO2、CERO2均明显升高,T2时血S100β蛋白、NSE水平均明显增加(P<0.05),与C组相比,T1及T2时Dex组患者上述指标均明显下降(P<0.05)。Dex组患者术后第1天及第3天时简易智能精神状态检查量表评分均高于C组(P<0.05)。结论:右美托咪定在老年椎弓根内固定手术过程中可发挥脑保护作用,降低脑氧代谢,减轻脑组织损伤,减少术后认知功能障碍的发生。Objective : To investigate the effect of dexmedetomidine on the postoperative cognitive function in elderly patients undergoing pedicle internal fixation under general anesthesia. Methods : Sixty patients with pedicle internal fixation, were selected and randomly divided into 2 groups(n=30 each) using a random number table: control group(group C) and dexmedetomidine group(group Dex). In group D, a loading dose of dexmedetomidine 0.5 μg·kg^-1 was infused intravenously for 10 min before surgery, and then dexmedetomid ine was infused at the rate of 0.2 μg·kg^-1·h^-1 during the operation until 30 min before the end of operation. Patients in group C received the same dose saline with the same way. Blood samples were collected at the following time points: T0(before the anesthesia induction), T1(the end of the operation), T2(24 h after the operation) to determine the Da-jvO2, CERO2 and the serum concentration of S100β, NSE. Results : Compared with T0, the Da-jvO2, CERO2 at T1 and the serum concentration of S100β, NSE at T2 were significantly increasedin the two groups(P<0.05). The parameters mentioned above and the occurrence rate of postoperative cognitive function in group Dex were significantly lower than those in group C(P<0.05). Conclusion : Dexmedetomidine can ruduce the occurrence rate of postoperative cognitive function in elderly patients undergoing pedicle internal fixation under general anesthesia.

关 键 词：椎弓根内固定术 认知功能 右美托咪定 老年患者 

分 类 号：R971.2[医药卫生—药品]