不同剂量右美托咪定对老年手术患者认知功能的影响  

Effect of different doses of dexmedetomidine on cognitive function in elderly patients undergoing oral and maxillofacial surgery

作　　者：韩晓菲 潘楚雄 张晓彤[1] 曹静[1] HAN Xiao-fei;PAN Chu-xiong;ZHANG Xiao-tong;CAO Jing(Department of Aneasthesia,Capital Medical University School of Stomatology,Beijing 100050,China)

机构地区：[1]首都医科大学口腔医学院麻醉科,北京100050

出　　处：《北京口腔医学》2020年第4期220-224,共5页Beijing Journal of Stomatology

摘　　要：目的探究不同剂量右美托咪定(Dex)对接受口腔颌面部手术的老年患者认知功能的影响。方法选取2018年6月至2019年9月于我院择期行口腔颌面部手术的老年患者195例,经过简单随机抽样双盲法将纳入者分为D1组(Dex 0.4μg/kg,n=47)、D2组(Dex 0.6μg/kg,n=49)、D3组(Dex 0.8μg/kg,n=48)和生理盐水对照组(NS组,n=51)。比较4组术前、术中、术后监测指标,S100蛋白和神经元特异性烯醇化酶(NSE),并采用手术应激指数(SSI)及简易精神状态检查量表(MMSE)评定患者认知功能,同时采用酶联免疫吸附(ELISA)测定S100蛋白和神经元特异性烯醇化酶(NSE)。结果 D1组、D2组、D3组用药后需吸引口腔内分泌物次数较NS组明显偏少(P<0.05)。4组术后24h SSI评分、S100蛋白及NSE水平较术前均显著升高,但D2组显著低于其他3组(P<0.05)。4组术后24h MMSE评分较术前均显著降低,但D2组显著高于其他3组(P<0.05)。结论麻醉诱导前应用中剂量(0.6μg/kg)Dex,可有效抑制口腔腺体分泌,对老年患者心肺系统影响较小,同时亦能够明显抑制NSE和S100β蛋白水平的升高,发挥脑保护效应和镇痛效果,对老年口腔颌面部手术患者认知功能影响较小,是此类患者理想的术前用药。Objective To investigate the effects of different doses of dexmedetomidine(Dex)on cognitive function in elderly patients undergoing oral and maxillofacial surgery.Methods A total of 195 elderly patients who underwent elective oral and maxillofacial surgery were selected.The patients were divided into D1 group(Dex 0.4μg/kg,n=47),D2 group(Dex 0.6μg/kg,n=49),D3 group(Dex 0.8μg/kg,n=48),and saline control group(NS group,n=51).Preoperative,intraoperative,and postoperative monitoring indicators,S100 protein,and neuron-specific enolase(NSE)were compared among the four groups.Surgical stress index(SSI)and simple mental state examination scale(MMSE)were used to assess the patient's perception.S100 protein and neuron-specific enolase(NSE)were measured by enzyme-linked immunosorbent assay(ELISA).Results The D1,D2,and D3 groups needed less oral suction than the control.The SSI score,S100 protein,and NSE levels of the 4 groups post operation were significantly higher than those before operation,but the D2 group was significantly lower than the other 3 groups(P<0.05).The MMSE scores of the 4 groups were significantly lower than those before the operation.But the D2 group was significantly higher than the other 3 groups(P<0.05).Conclusion Before anesthesia induction,moderate dose(0.6μg/kg)DEX can significantly inhibit the NSE and S100βprotein levels and have little effect on the cognitive function of elderly patients undergoing oral and maxillofacial surgery.

关 键 词：右美托咪定 剂量 手术 老年患者 认知功能 

分 类 号：R782.05[医药卫生—口腔医学]