右美托咪定对闭环靶控吸入七氟醚麻醉老年腹部手术患者术后谵妄发生和炎症因子、AChE活性的影响  

Effect of dexmedetomidine on postoperative delirium,inflammatory factors and AChE activity in elderly patients undergoing abdominal surgery under closed-loop target-controlled inhalation of sevoflurane anesthesia

作　　者：李玉霞 彭景燕 王春平 宋君梅 郭君 LI Yu-xia;PENG Jing-yan;WANG Chun-ping;SONG Jun-mei;GUO Jun(Department of Anesthesiology,Shijiazhuang People's Hospital,Shijiazhuang 050000,Hebei,China)

机构地区：[1]石家庄市人民医院麻醉科,河北石家庄050000

出　　处：《川北医学院学报》2022年第8期996-999,共4页Journal of North Sichuan Medical College

基　　金：河北省医学科学研究重点课题计划项目(20181001)。

摘　　要：目的:观察术中应用右美托咪定对闭环靶控吸入七氟醚麻醉老年腹部手术患者术后谵妄(POD)的影响,并探讨可能的机制。方法:选取120例拟行腹部手术的老年患者为研究对象,根据是否输注右美托咪定分为对照组与观察组,每组各60例。麻醉诱导开始,观察组予以右美托咪定0.4μg·kg^(-1)·h^(-1)持续输注;对照组予以等量生理盐水输注;两组患者均予以闭环靶控吸入七氟醚麻醉。比较两组患者拔管后5 min和30 min疼痛视觉模拟评分(VAS)和镇静躁动评分(RSAS);术后72 h内POD发生率;谵妄持续时间和术后住院时间;术前及术后1 h血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及乙酰胆碱酯酶(AChE)水平;不良反应发生情况。结果:与对照组比较,观察组患者拔管后30 minVAS评分及拔管后5 min、30 min RSAS评分均降低(P<0.05);术后3 d POD发生率降低(P<0.05),谵妄持续时间和住院时间缩短(P<0.05)。术后1 h,两组患者血清IL-6、TNF-α水平相比术前增高(P<0.05),且观察组低于对照组(P<0.05);AChE水平相比术前降低(P<0.05),且观察组高于对照组(P<0.05)。两组患者术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论:对于闭环靶控吸入七氟醚麻醉的老年腹部手术患者,术中使用右美托咪定有助于减少POD发生,抑制炎症反应和改善AChE活性可能是其潜在机制。Objective:To observe the effect of dexmedetomidine on postoperative delirium(POD)in elderly patients undergoing abdominal surgery under closed-loop target-controlled inhalation of sevoflurane anesthesia,and to explore the possible mechanism.Methods:A total of 120 elderly patients scheduled for abdominal surgery were divided into control group(n=60)and observation group(n=60)according to whether or not dexmedetomidine infusion.At the beginning of anesthesia induction,the observation group was given continuous infusion of dexmedetomidine 0.4μg·kg^(-1)·h^(-1),while the control group was given equal volume of normal saline.Both groups were given closed-loop target-controlled inhalation of sevoflurane anesthesia.The visual analogue scale(VAS)and riker sedation-agitation scale(RSAS)were recorded at 5 min and 30 min after extubation.POD incidence,delirium duration and postoperative hospital stay within 72 h after operation were recorded in the two groups.The serum levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and acetylcholinesterase(AChE)were detected before and 1 hour after operation.The adverse reactions in the two groups were recorded.Results:Compared with the control group,the VAS score at 30 min and the RSAS score at 5 min and 30 min after extubation in the observation group were significantly decreased(P<0.05).The incidence of POD in the observation group was significantly reduced,the duration of delirium and hospitalization time were shortened(P<0.05).At 1 h after operation,serum IL-6 and TNF-α in the two groups were higher than those before operation(P<0.05),and the observation group was lower than the control group(P<0.05).AChE was lower than that before operation(P<0.05),and the observation group was higher than the control group(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:For elderly patients undergoing abdominal surgery under closed-loop target-controlled inhalation of sevoflurane anesthesia,int

关 键 词：右美托咪定 老年人 腹部手术 谵妄 闭环靶控 七氟醚 炎症反应 乙酰胆碱酯酶 

分 类 号：R614.2[医药卫生—麻醉学]