七氟醚全麻与七氟醚复合右美托咪定麻醉对老年患者术后认知功能的影响对比  

Effects of Sevoflurane Alone and Sevoflurane Combined with Dexmedetomidine on Postoperative Cognitive Function in Older Patients

作　　者：彭赛 滕永杰[1] 周启 Peng Sai;Teng Yongjie;Zhou Qi(The First Affiliated Hospital,Hunan University of Traditional Chinese Medicine,Changsha 410007)

机构地区：[1]湖南中医药大学第一附属医院,长沙410007

出　　处：《国际老年医学杂志》2022年第3期342-345,共4页International Journal of Geriatrics

基　　金：湖南省卫生健康委科研计划课题项目(B20180642)。

摘　　要：目的探讨单纯七氟醚全麻与七氟醚复合右美托咪定麻醉对老年腹腔镜直肠癌根治术患者术后认知功能的影响。方法选取2019年4~12月择期全麻下行腹腔镜直肠癌根治术的60例老年患者作为研究对象,按照随机数字表法分为右美托咪定+七氟醚组(联合组)和七氟醚组(单独组),各30例。常规监测、常规全麻诱导气管插管,特殊持续监测局部脑氧饱和度(rSO2)。联合组诱导前10 min内微量泵注0.8μg/kg右美托咪定,之后以0.3μg/(kg·h)的速度持续泵注,手术结束前30 min停止,并吸入0.5最低肺泡有效浓度(MAC)的七氟醚维持麻醉;单独组患者单纯吸入1.0~1.5 MAC七氟醚维持麻醉;两组均持续静脉泵注瑞芬太尼。结果联合组在气管插管、切皮时、手术开始后1 h、拔管时的平均动脉压、心率低于单独组(P﹤0.05);联合组术后1 d、3 d、7 d肿瘤坏死因子α和白细胞介素1β均明显低于单独组(P﹤0.05);联合组术后Riker镇静-躁动评分低于单独组(P﹤0.05);联合组术后3 d、7 d时认知功能障碍发生率低于单独组(P﹤0.05)。结论对于腹腔镜直肠癌根治术的老年患者,相比于单纯七氟醚全麻,右美托咪定复合七氟醚全麻更有利于改善术后认知功能,与右美托咪定减轻围术期神经炎症有关。Objective To investigate the effects of sevoflurane alone and sevoflurane combined with dexmedetomidine on cognitive function in older patients after laparoscopic radical resection for rectal cancer.Methods Sixty older patients undergoing laparoscopic radical resection for rectal cancer under general anesthesia from April to December 2019 were selected, and randomly divided into the combination group(30 cases received dexamethasone plus sevoflurane) and the sevoflurane group(30 cases received sevoflurane alone).Routine monitoring, endotracheal intubation induced by routine general anesthesia, and special continuous monitoring of cerebral regional oxygen saturation(rSO2) were performed.In the combination group, dexmedetomidine at a dose of 0.8 μg/kg was administered within 10 min, then continuously administered at the speed of 0.3 μg/(kg·h).It was stopped 30 minutes before the end of the operation, and the anesthesia was maintained by inhaling 0.5 minimum alveolar concentration(MAC) of sevoflurane.In the sevoflurane group, the anesthesia was maintained by inhaling 1.0 to 1.5 MAC of sevoflurane.The patients in both groups received continuous intravenous infusion of remifentanil.Results In the combination group, the mean arterial pressure and heart rate were lower than those in the sevoflurane group at the time of endotracheal intubation, skin incision, 1 hour after operation and tracheal extubation(P<0.05).In the combination group, the levels of tumor necrosis factor-α and interleukin-1β were significantly lower than those in the sevoflurane group at 1 day, 3 days and 7 days after operation(P<0.05).Riker sedative-agitation score in the combination group was lower than that in the sevoflurane group(P<0.05).The incidence of cognitive dysfunction in the combination group was lower than that in the sevoflurane group at 3 days and 7 days after operation(P<0.05).Conclusion Compared with general anesthesia with sevoflurane alone, dexmedetomidine combined with sevoflurane is more beneficial to improve postoperative co

关 键 词：右美托咪定 七氟醚 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]