右美托咪定全身麻醉对老年肿瘤手术患者脑血流动力学和应激反应的影响研究  

Effects of Cerebral Hemodynamics,Stress and Postoperative Cognitive Function on Dexmedetomidine in Elderly Patients with Tumor

作　　者：曹喜华[1] 王帅[2] 徐国亭[1] 李好朝 CAO Xihua;WANG Shuai;XU Guoting(The First Affiliated Hospital of Henan Nanyang Medical College,Nanyang,473000)

机构地区：[1]河南省南阳医学高等专科学校第一附属医院,473000 [2]河南省南阳医学高等专科学校,473000

出　　处：《实用癌症杂志》2021年第11期1909-1912,共4页The Practical Journal of Cancer

基　　金：河南省医学科技攻关计划项目(编号:2018052236)。

摘　　要：目的探讨右美托咪定全身麻醉对老年肿瘤患者手术中脑血流动力学、应激及术后认知功能的影响。方法选取择期全身麻醉下进行开腹手术治疗的肿瘤患者100例,随机分为对照组与观察组,每组50例,两组麻醉诱导及麻醉维持药物相同,观察组麻醉诱导前给予右美托咪定并术中维持,对照组给予等量生理盐水,观察术前(T0)、手术开始后2 h(T1)、术毕时(T2)的脑血流动力学、应激反应变化,手术前30 min和术后24 h、术后3 d时认知功能变化。结果两组患者脉搏波波速(Wv)、动态阻力(DR)在T1时与T0时比较升高,在T2时有所恢复,血流量(Qmean)、临界压(CP)在T1时与T0时比较下降,在T2时有所恢复,对照组变化幅度明显大于观察组,两组组间、两组不同时间点间、不同时间点间交互比较差异均有统计学意义(P<0.05)。两组患者血去甲肾上腺素(NE)、肾上腺素(E)、肾素(R)在T1和T2时均较T0时升高,T2时较T1时有所下降,对照组变化幅度明显大于观察组,两组组间、两组不同时间点间、不同时间点间交互比较差异均有统计学意义(P<0.05)。两组患者简易智能状态量表(MMSE)评分在术后24 h和术后3 d时较术前30 min时明显下降,术后3 d时有所升高,对照组变化幅度明显大于观察组,两组组间、两组不同时间点间、不同时间点间交互比较均差异有统计学意义(P<0.05)。结论右美托咪定全身麻醉用于老年肿瘤患者在麻醉诱导前辅助麻醉有助于维持脑血流动力学稳定,减轻术中应激反应及术后认知功能障碍的发生。Objective To investigate the effects of cerebral hemodynamics,stress and postoperative cognitive function on dexmedetomidine in elderly patients with tumor.Methods 100 cases of tumor patients undergoing laparotomy under elective general anesthesia were selected and were randomly divided into the control group and the observation group,with 50 cases in each group.The anesthesia induction and maintenance drugs were the same in the 2 groups,dexmedetomidine was administered before anesthesia induction and maintained intraoperatively in the observation group,the control group was given the same amount of normal saline.To observed the changes of cerebral hemodynamics and stress response in inpreoperative(T0),2h intraoperative(T1)and 2h postoperative(T2),cognitive function in 30min inpreoperative,24h postoperative,and 3d postoperative.Results The Wv and DR in the 2 groups were increased at T1,and recovered at T2,Qmean and CP decreased at T1,but recovered at T2,the change amplitude of the control group was significantly larger than that of the observation group,interactions between the 2 groups,and at different time points,and between groups at different time points,the differences were statistically significant(P<0.05).NE and E and R at T1 and T2 were higher than T0,at T2 was lowere than at T1,the change amplitude of the control group was significantly larger than that of the observation group,interactions between the 2 groups,between the 2 groups at different time points,and between groups at different time points,the differences were statistically significant(P<0.05).The scores of MMSE in the 2 groups were significantly decreased at 24h and 3d postoperative compared with 30min inpreoperative,and recovered at 3d postoperative,interactions between the 2 groups,between the 2 groups at different time points,and between groups at different time points,the differences were statistically significant(P<0.05).Conclusion Dexmedetomidine is used in general anesthesia toassist anesthesia before induction in elderly tumor patients

关 键 词：右美托咪定 全身麻醉 脑血流动力学 应激反应 认知功能 老年 

分 类 号：R73-36[医药卫生—肿瘤]