文献类型：期刊文献

中文题名：右美托咪定对全身麻醉老年患者术后认知功能的影响

英文题名：Effect of dexmedetomidine on elderly patients’ cognitive dysfunction after general anesthesia

作者：董良坤[1];冯秀玲[1]

第一作者：董良坤

机构：[1]甘肃中医药大学附属医院麻醉手术科,甘肃兰州730020

第一机构：甘肃中医药大学第二附属医院

年份：2021

卷号：47

期号：3

起止页码：17

中文期刊名：兰州大学学报：医学版

收录：CSTPCD

基金：甘肃省卫生行业科研计划项目(GSWSKY-2014-48)。

语种：中文

中文关键词：全身麻醉;右美托咪定;术后认知功能障碍;炎性因子

外文关键词：general anesthesia;dexmedetomidine;postoperative cognitive dysfunction;inflammatory factor

摘要：目的探讨右美托咪定对老年患者全身麻醉术后认知功能的影响。方法选择2015年9月—2016年9月在甘肃中医药大学附属医院接受全身麻醉的老年患者160例,随机分为右美托咪定组(A组)和对照组(B组)。A组在全身麻醉诱导前10 min内预先输注右美托咪定负荷剂量0.8μg/kg,之后以0.5μg/(kg·h)恒速维持输注至手术结束前30 min。观察并记录2组患者术前(T_(0))、插管前(T_(1))、插管后5 min (T_(2))、手术开始后10 min (T_(3))、手术开始后30 min (T_(4))、停药后10 min (T_(5))、拔管前(T_(6))、拔管后(T_(7))的平均动脉压(MAP)、心率(HR)、麻醉深度(AI);从停止给药到患者自主呼吸恢复的时间(T_(8))、呼之睁眼的时间(T_(9))、拔管的时间(T_(10))、定向力恢复的时间(T_(11));检测并记录患者手术前1 d、术毕、术后24 h、术后72 h的血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)、C反应蛋白(CPR)水平;应用简易精神状态评价量表(MMSE)测试并记录患者术前1 d,术后1、3、7、14 d的MMSE评分。结果 2组患者在T_(0)时MAP、HR、AI差异无统计学意义(P>0.05)。A组患者MAP在T_(1)与T_(0)时比较,差异有统计学意义(P<0.05),HR在T_(1)、T_(2)、T_(6)与T_(0)时比较,差异有统计学意义(P<0.05);B组患者MAP在T_(1)、T_(2)、T_(3)、T_(5)、T_(6)、T_(7)与T_(0)时比较,差异有统计学意义(P<0.05),HR在T_(1)、T_(2)、T_(4)、T_(5)、T_(6)、T_(7)与T_(0)时比较,差异有统计学意义(P<0.05)。A组患者AI在T_(5)、T_(6)、T_(7)时高于B组,且差异有统计学意义(P<0.05);2组患者T_(8)、T_(9)、T_(10)、T_(11)差异无统计学意义(P>0.05)。2组患者术前1 d血浆中TNF-α、IL-6、CPR水平差异无统计学意义(P>0.05)。与B组患者比较,A组患者术毕、术后24 h、术后72 h各炎性因子表达水平均降低,差异有统计学意义(P<0.05);2组患者术前MMSE评分差异无统计学意义(P>0.05);与B组患者比较,A组患者术后1、3、7 d MMSE评分明显高于对照组,差异有统计学意义(P<0.05)。A组患者术后各时间点MMES评分与术前差异无统计学意义(P>0.05);B组患者术后1 d与术后3 d MMES评分较术前降低,差异有统计学意义(P<0.05)。结论右美托咪定可维持老年患者全身麻醉术后的血流动力学稳定,提高复苏质量,降低机体炎性因子水平,减轻术后认知功能障碍。
Objective To investigate the effect of dexmedetomidine on elderly patients’ cognitive function after they accepted general anesthesia. Methods 160 elderly patients who accepted general anesthesia during September 2015 to September 2016 in the Affiliated Hospital of Gansu University of Chinese Medicine were randomly divided into 2 groups: the dexmedetomidine group(group A) and the control group(group B).Group A was given dexmedetomidine with an amount of 0.8 μg/kg during the 10 minutes prior to the induction, and followed by a constant rate of 0.5 μg/(kg·h) till 30 minutes before the end of the operation. The following indexes for both groups were observed and recorded: the mean arterial pressure(MAP), heart rate(HR) and depth of anesthesia(AI) before the operation(T_(0)), before the intubation(T_(1)), 5 minutes after intubation(T_(2)), 10 minutes after operation(T_(3)), 30 minutes after operation(T_(4)), 10 minutes after drug withdrawal(T_(5)), before the extubation(T_(6)), and after the extubation(T_(7)), respectively;the recovery time of spontaneous breathing(T_(8)) and the time to open eyes(T_(9)), extubation time(T_(10)), directional force recovery time(T_(11))counted from the moment when drug administration was stopped;the patients’ plasma tumor necrosis factor-α(TNF-α), C-reactive protein(CPR) and interleukin-6(IL-6) indexes one day before the operation, at the end of the operation, 24 h after the operation and 72 h after the operation, and mini mental state assessment scale(MMSE) scores at 1 day before the operation, 1, 3, 7 and 14 days after the operation, respectively.Results Compared with their own T_(0) before the operation, for group A, the MAP value at T_(1) and T_(0), and the HR values at T_(1), T_(2) and T_(6) were significantly different(P< 0.05);and for group B, the MAP at T_(1), T_(2), T_(3), T_(5),T_(6), T_(7) were significantly different from the one at T_(0)(P< 0.05), HR at T_(1), T_(2), T_(4), T_(5), T_(6), T_(7) were significantly different from that at T_(0) value(P< 0.05). Compared with group B, AI in group A was obviously higher at T_(5),T_(6) and T_(7)(P< 0.05);no noticeable improvement was observed in the recovery time of spontaneous breathing,extubation and orientation in group A;the plasma levels of TNF-α, CPR and IL-6 in group A at 1 d before the operation, at the end of the operation, 24 h after the operation and 72 h after the operation were significantly decreased;and compared with that before operation, there was no difference in MMES between group A and before operation(P >0.05), while MMES score of group B decreased at 1 d and 3 d after operation(P<0.05);compared with group B, MMSE score of group A was significantly higher than that of the control group on 1, 3 and 7 d after operation(P< 0.05). Conclusion Dexmedetomidine can maintain the hemodynamic stability of elderly patients after general anesthesia, improve the quality of recovery, reduce the level of patients’ inflammatory factors and reduce cognitive dysfunction.