| 右美托咪定对老年脊柱手术患者应激反应和术后早期认知功能的影响 |
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| 引用本文： | 张曙报,梅玫,吕文艳,胡小华.右美托咪定对老年脊柱手术患者应激反应和术后早期认知功能的影响[J].中华全科医学,2017,15(2):249. |
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| 作者姓名： | 张曙报 梅玫 吕文艳 胡小华 |
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| 作者单位： | 1. 解放军第117医院麻醉科, 浙江 杭州 310004; |
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| 摘 要： | 目的 探讨右美托咪定对老年脊柱手术患者应激反应和术后早期认知功能的影响。 方法 将解放军第117医院2015年2月-2016年9月期间收治的66例老年脊柱手术患者随机分为右美托咪定组(观察组)和生理盐水组(对照组),每组33例,2组麻醉诱导和术中麻醉维持所用药物及剂量相同,观察组在麻醉诱导前静脉输注右美托咪定负荷剂量0.5 μg/kg,持续输注15 min,然后以0.3 μg/(kg·h)的速度持续泵注到手术结束前30 min。采用ELISA法测定2组患者不同时间的皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、肾上腺素(E)、去甲肾上腺素(NE)等应激反应相关指标和认知功能相关的血清标志物S-100β蛋白(S-100β)、血清肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)的浓度,采用简易智能评分量表(MMSE)观察认知障碍(POCD)的发生率。 结果 经t检验,对照组术后1、4、8、12 h的Cor水平均较麻醉前10 min显著升高(P<0.05),且术后各时间点均显著高于观察组(P<0.05);观察组术后1、4、8、12、24 h的AngⅡ、NE、E水平均较麻醉前10 min显著降低(P<0.05),且明显低于同时间点的对照组(P<0.05);对照组术后1、3、5 d的S-100β、TNF-α、IL-6均较术前1 d显著升高(P<0.05),且高于同时间点的观察组(P<0.05);对照组术后1、3、5 d的MMSE评分均较术前1 d显著降低(P<0.05),且明显低于同期的观察组(P<0.05);经χ2检验,观察组术后1、3.5 d的POCD发生率显著低于对照组(P<0.05)。 结论 在老年患者脊柱手术中应用右美托咪定可以显著降低术后24 h的应激反应和早期认知功能障碍的发生率。
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| 关 键 词： | 右美托咪定 脊柱手术 应激反应 术后认知功能障碍 |
| 收稿时间： | 2016-09-09 |
Influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation |
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| Affiliation: | Department of Anesthesiology, the 117th Hospital of PLA, Hangzhou, Zhejiang 310004, China |
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| Abstract: | Objective To study the influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation. Methods A total of 66 elderly patients undergoing spinal surgery in our hospital between February,2015 and September,2016 were enrolled and randomly divided into dexmedetomidine group (observation group) and saline group (control group) with 33 patients in each group.All patients were given same anesthesia induction and intraoperative anesthesia maintenance with same drugs and doses,but patients in the observation group were given dexmedetomidine with loading dose 0.5 μg/kg before anesthesia induction,after 15 min continuous infusion,and then at the speed of 0.3 μg/(kg·h) until 30 min before the end of surgery.The stress related index such as serum cortiso (Cor),Angiotensin Ⅱ(Ang Ⅱ),epinephrine (E),norepinephrine (NE) levels,and the cognitive function related index such as S-100β protein (S-100β),serum tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) levels were tested by ELISA;The Mini Mental State Examination (MMSE) was used to systematically assess the incidence of postoperative cognitive dysfunction (POCD). Results Cor level in the control group at 1,4,8 and 12 hours after surgery increased significantly as compared with that 10 min before anesthesia,which was significantly higher than those in the observation group (P<0.05);The levels of Ang Ⅱ,NE and E at 1,4,8,12 and 24 hours after the surgery all decreased significantly as compared with those 10 min before the anesthesia,and they were lower than those of control group with statistical significance (P<0.05);the levels of S-100β,TNF-α and IL-6 at 1,3 and 5 days after the surgery in the control observation group were significantly higher than those 1 day before the surgery (P<0.05),and they were all higher than those of observation group with statistical significance (P<0.05);The MMSE score at 1,3 and 5 days after the surgery in the control group was much lower than those 1 day before the surgery (P<0.05),and they were all lower than those of observation group with statistical significance (P<0.05);The incidence of POCD at 1 and 3 days after the surgery in the observation group were lower than control group with statistical significance (P<0.05). Conclusion The application of dexmedetomidine in elderly patients with spinal surgery can reduce the stress response in 24 hour and the incidence of early postoperative cognitive dysfunction. |
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