不同剂量右美托咪定对老年髋关节置换术患者认知功能的影响  

Effects of different doses of dexmedetomidine on cognitive function in elderly patients undergoing hip replacement

作　　者：王海丽[1] 潘华[1] 杨爱玲 赵喜波 王怡君 屈海波[1] Wang Haili;Pan Hua;Yang Ailing;Zhao Xibo;Wang Yijun;Qu Haibo(Sanmenxia Central Hospital,Sanmenxia 472000,Henan,China)

机构地区：[1]三门峡市中心医院,河南三门峡472000

出　　处：《临床心身疾病杂志》2022年第3期29-34,45,共7页Journal of Clinical Psychosomatic Diseases

基　　金：三门峡市科技发展计划项目(编号2019060324)。

摘　　要：目的探讨不同剂量右美托咪定对老年髋关节置换术患者认知功能的影响。方法将120例接受髋关节置换术的老年患者按照随机数字表法分为小剂量组、中剂量组、大剂量组与对照组,各30例。所有患者麻醉前15 min开始持续泵注药物,小剂量组持续泵入0.2μg·kg^(-1)的右美托咪定、中剂量组持续泵入0.5μg·kg^(-1)的右美托咪定、大剂量组持续泵入0.8μg·kg^(-1)的右美托咪定、对照组持续注入生理盐水。比较4组手术时长及麻醉时长。比较4组患者术中各时间点平均动脉压、心率。比较4组各时间点白细胞介素-6、肿瘤坏死因子-α及超氧化物歧化酶水平。术前1 d及术后7 d比较4组患者蒙特利尔认知评估量表评分及术后认知功能障碍发生率。结果4组手术时长及麻醉时长比较差异无统计学意义(P>0.05)。术后7 d 4组蒙特利尔认知评估量表评分均显著低于术前1 d(P<0.05),中剂量组、大剂量组术后认知功能障碍发生率显著低于对照组(P<0.05)。T1~T4时间点中剂量组及大剂量组心率水平均显著低于T0时间点(P<0.05),T1、T2时间点中剂量组心率水平显著低于对照组(P<0.05),T1~T4时间点大剂量组心率水平显著低于对照组(P<0.05),大剂量组术中心率波动最大。T4及T5时间点4组白细胞介素-6及肿瘤坏死因子-α水平均显著高于T0时间点(P<0.05),超氧化物歧化酶水平显著低于T0时间点(P<0.05)。T4时间点小剂量组、中剂量组白细胞介素-6水平显著高于大剂量组(P<0.05),小剂量组、中剂量组肿瘤坏死因子-α水平显著高于大剂量组(P<0.05),小剂量组超氧化物歧化酶水平显著低于大剂量组(P<0.05)。T5时间点小剂量组白细胞介素-6水平显著高于大剂量组(P<0.05),小剂量组肿瘤坏死因子-α水平显著高于大剂量组(P<0.05),小剂量组超氧化物歧化酶水平显著低于大剂量组(P<0.05)。结论持续泵入0.5μg·kg^(-1)的右美托咪定可以有效�Objective To investigate the effects of different doses of dexmedetomidine on cognitive function in elderly patients undergoing hip replacement.Methods A total of 120 elderly patients undergoing hip replacement were divided into a low-dose group,a medium-dose group,a high-dose group and a control group according to random number table method,with 30 cases in each group.All patients began to pump drugs continuously 15 minutes before anesthesia.The low-dose group was continuously pumped with 0.2μg·kg^(-1) of dexmedetomidine,the medium-dose group was continuously pumped with 0.5μg·kg^(-1) of dexmedetomidine,the high-dose group was continuously pumped with 0.8μg·kg^(-1) dexmedetomidine,and the control group was continuously injected with normal saline.The operation time and anesthesia time of the 4 groups were compared.The mean artery pressure(MAP)and heart rate(HR)at each time point in the 4 groups were compared.The levels of interleukin 6(IL-6)、tumor necrosis factor-α(TNF-α)and superoxide dismutase(SOD)at each time point in the 4 groups were compared.The Montreal cognitive assessment(MoCA)score and the incidence of postoperative cognitive dysfunction were compared among the 4 groups at 1 day before operation and 7 days after operation.Results There was no significant difference in operation time and anesthesia time among the 4 groups(P>0.05).On the 7th day after operation,the MoCA scores of the 4 groups were significantly lower than those on the 1st day before operation(P<0.05),the incidence of postoperative cognitive dysfunction in the medium-dose group and high-dose group was significantly lower than that in the control group(P<0.05).The HR levels in the medium-dose group and the high-dose group at T1-T4 were significantly lower than those at T0(P<0.05),the HR levels in the medium-dose group at T1 and T2 were significantly lower than those of the control group(P<0.05),the HR levels in the high-dose group at T1-T4 were significantly lower than those of the control group(P<0.05),and the heart rate fluctua

关 键 词：髋关节置换术 老年 右美托咪定 术后认知功能障碍 

分 类 号：R614.24[医药卫生—麻醉学] R683.3[医药卫生—外科学]