右美托咪定预处理对老年患者纤维支气管镜检查后早期认知功能障碍的影响  

Effect of dexmedetomidine pretreatment on early cognitive dysfunction in elderly patients after fiberoptic bronchoscopy

作　　者：何军 孙丽 高龙飞 张徽 杨倩[1] 蒯建科 HE Jun;SUN Li;GAO Long-fei;ZHANG Hui;YANG Qian;KUAI Jian-ke(the Affiliated Hospital of Northwest University/Xi'an No.3 Hospital,Xi'an 710018;the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]西北大学附属医院/西安市第三医院,陕西西安710018 [2]空军军医大学第二附属医院,陕西西安710038

出　　处：《临床医学研究与实践》2020年第17期23-24,37,共3页Clinical Research and Practice

基　　金：陕西省自然科学基础研究计划项目(No.2019JQ-985)。

摘　　要：目的 探讨右美托咪定预处理对老年患者纤维支气管镜检查后早期认知功能障碍的影响.方法 将我院行纤维支气管镜检查的63例老年患者根据麻醉诱导药物不同分为三组,每组21例.R组诱导前给予生理盐水0.25 mL/kg,诱导给予丙泊酚(1.5 mg/kg)+瑞芬太尼(1μg/kg)+罗库溴铵(0.2 mg/kg);D1组给予右美托咪定1μg/kg预处理+同R组麻醉诱导药物;D2组给予右美托咪定1μg/kg预处理,诱导给予丙泊酚(1.0 mg/kg)+瑞芬太尼(0.8μg/kg)+罗库溴铵(0.2 mg/kg).比较三组的麻醉效果.结果 D1组T1、T2、T4时HR低于R组,T1、T2时MAP低于R组(P<0.05).D2组T2、T4时HR低于R组,T1、T2时MAP高于D1组(P<0.05).D1组苏醒时间长于R组(P<0.05).D2组苏醒时间短于D1组和R组(P<0.05).D1组术后躁动和呼吸抑制发生率均低于R组(P<0.05).D2组术后躁动、呼吸抑制和恶心发生率均低于R组(P<0.05).手术后1、2、3 d,D1组和D2组的MMSE评分高于R组,S-100β水平和术后早期认知功能障碍发生率低于R组(P<0.05).结论 右美托咪定预处理能减少老年患者纤维支气管镜检查后早期认知功能障碍和不良反应,减少麻醉药物用量.Objective To investigate the effect of dexmedetomidine pretreatment on early cognitive dysfunction in elderly patients after fiberoptic bronchoscopy.Methods Sixty-three elderly patients undergoing fiberoptic bronchoscopy in our hospital were divided into three groups according to different anesthesia inducing drugs,with 21 caes in each group.The group R was given 0.25 mL/kg normal saline before induction,propofol(1.5 mg/kg)+remifentanil(1μg/kg)+rocuronium(0.2 mg/kg)after induction;the group D1 was pretreated with 1μg/kg dexmedetomidine and given the same anesthesia induction drug as the group R;the group D2 was pretreated with 1μg/kg dexmedetomidine and induced to receive propofol(1.0 mg/kg)+remifentanil(0.8μg/kg)+rocuronium(0.2 mg/kg).The anesthetic effects of the three groups were compared.Results HR at T1,T2 and T4 in the group D1 were lower than those in the group R,and MAP at T1 and T2 were lower than those in the group R(P<0.05).HR at T2 and T4 in the group D2 were lower than those in the group R,and MAP at T1 and T2 were higher than those in the group D1(P<0.05).The recovery time of the group D1 was longer than that of the group R(P<0.05).The recovery time of the group D2 was shorter than that of the group D1 and group R(P<0.05).The incidences of restlessness and respiratory depression in the group D1 were lower than those in the group R(P<0.05).The incidences of restlessness,respiratory depression and nausea in the group D2 were lower than those in the group R(P<0.05).On the 1st,2nd and 3rd day after operation,the MMSE scores of the group D1 and group D2 were higher than those of the group R,the levels of S-100βand the incidences of early postoperative cognitive dysfunction were lower than those of the group R(P<0.05).Conclusion Dexmedetomidine pretreatment can reduce the early cognitive dysfunction and adverse reactions of the elderly patients after fiberoptic bronchoscopy,and reduce the dosage of narcotic drugs.

关 键 词：右美托咪定 认知功能障碍 纤维支气管镜检查 老年人 

分 类 号：R614[医药卫生—麻醉学]