硬膜外注射右美托咪定的镇痛镇静效应及对认知功能的影响  

Analgesic and sedative effects of epidural dexmedetomidine injection and its effect on cognitive function

作　　者：于江 程若竹 陈宣羽 王莹[1] 杨雪利 陈宏志[1] Yu Jiang;Cheng Ruozhu;Chen Xuanyu;Wang Ying;Yang Xueli;Chen Hongzhi(Department of Anesthesiology,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《中国医师进修杂志》2019年第10期874-879,共6页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省自然科学基金(2018225010).

摘　　要：目的观察硬膜外注射右美托咪定在经尿道前列腺电切术(TURP)患者中的镇痛镇静效应以及对术后认知功能的影响.方法选取2018年4—7月在中国医科大学附属盛京医院麻醉科腰硬联合麻醉(CSEA)下行TURP患者60例,随机分为右美托咪定组和0.9%氯化钠组.右美托咪定组患者麻醉后硬膜外给予0.1 μg/kg右美托咪定注射液3 ml,术后硬膜外镇痛泵中含0.1%罗哌卡因以及0.9 μg/kg右美托咪定注射液共275 ml.0.9%氯化钠组麻醉后硬膜外给予0.9%氯化钠3 ml,术后硬膜外镇痛泵中含0.1%罗哌卡因注射液275 ml.记录两组患者不同时刻[干预前(T0)、干预后15 min(T1)、干预后30 min(T2)、干预后45 min(T3)、干预后60 min(T4)、手术结束后12 h(T5)、手术结束后36 h(T6)]的生命体征、视觉模拟评分(VAS)、Ramsay镇静评分;记录两组患者术前1 d及术后3 d简易智力状态评分(MMSE).结果与0.9%氯化钠组相比,右美托咪定组患者VAS评分在T1~T6时刻降低(P<0.05),Ramsay评分升高(P<0.05).与0.9%氯化钠组相比,右美托咪定组患者术后3 d MMSE总分[25.00(23.50,27.50)分]无明显变化,但其记忆能力评分[4.00(3.00,5.00)分]降低(P<0.05),语言能力评分[9.00(8.00,9.00)分]升高(P<0.05).与术前1 d相比,两组患者MMSE评分均未出现变化.结论硬膜外注射右美托咪定(1 μg/kg)能加强罗哌卡因的镇痛作用,并产生镇静效应.虽然未见其对整体认知功能产生显著影响,但可能对记忆功能产生一定影响.Objective To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function. Methods A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation;patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points[before intervention (T0), after intervention for 15 min (T1), after intervention for 30 min (T2), after intervention for 45 min (T3), after intervention for 60 min (T4), after surgery for 12 h (T5), after surgery for 36 h (T6)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded. Results Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T1-T6 (P < 0.05), and the Ramsay scores were significantly higher (P < 0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P < 0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation. Conclusions Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might ha

关 键 词：麻醉 硬膜外 右美托咪定 经尿道前列腺电切术 认知功能 

分 类 号：R614[医药卫生—麻醉学]