脑氧饱和度监测与右美托咪定麻醉下术后认知变化的关系

目的：探讨围术期脑氧饱和度（rS（O2））与静吸复合右美托咪定麻醉下老年患者术后认知功能变化的关系,为临床麻醉提供指导。方法：60例美国麻醉医师协会（ASA）Ⅰ～Ⅱ级,年龄〉60岁的患者,行择期腹部及下肢手术。随机分为3组：右美托咪定组（D组）、咪唑安定组（M组）和空白对照组（C组）,每组20例。3组患者的一般情况比较无明显差异（P〉0.05）。应用脑氧饱和度监测麻醉下患者的脑氧变化状态,通过脑氧变化来观察术后的脑认知状态。应用简易智力状态检查（MMSE）、连线测试及凹槽拼板测试来评定3组患者术前24 h,术后4、8、12、24 h的认知功能变化。结果：（1）3组患者在围术期同一阶段下,脑氧饱和度值变化不明显,无明显的统计学差异（P〉0.05）。所有患者术后4、8、12 h的MMSE评分与患者入室时相比均明显降低（P〈0.05）。（2）3组患者连线测试（trail-making test）与凹槽拼板测试（grooved pegboard test）的结果表明：D组患者任务完成的时间明显缩短,M组患者完成任务的时间延长。（3）术后4 h,发生认知功能变化的,M组中有3例（15%）患者,C组中有2例（10%）患者,D组有1例（5%）患者;术后8 h,发生认知功能变化的,M组中有2例（10%）患者,C组中有1例（5%）患者,D组患者认知功能基本恢复;术后12 h,仅有M组中有1例（5%）患者出现认知功能不全,其余组患者认知均恢复;术后24 h,所有组患者的认知功能均恢复。结论：右美托咪定在静吸麻醉中的复合应用,能降低老年患者术后认知功能障碍的发生,可能与其独特的自然睡眠状态及神经保护抗炎作用和全麻协同作用有关。

Relationship between cerebral oxygen saturation detection and postoperative cognitive function changes under anesthesia by dexmedetomidine

Objective To discuss the relationship between the perioperative cerebral oxygen saturation（rS（O2）） and the postoperative cognitive function changes for the elderly patients under intravenous inhalational anesthesia by dexmedetomidine, so as to provide references to clinical anesthesia. Methods Sixty ASA Ⅰ- Ⅱ patients, aged more than 60 yrs and scheduled for selective abdominal or lower limb surgeries were enrolled and randomly divided into 3 groups, including dexmedetomidine group（group D）, midazolam group（group M） and control group（group C）, with 20 patients in each group.There was no difference between the general conditions of the patients in the three groups（P〉0.05）. All patients were monitored with the cerebral oximeter（rS（O2）） and the conditions of cerebral oxygenation were recorded to reflect the patients＇ cognitive function during operation. Cerebral oximeter（rS（O2）） was continuously monitored and recorded in operation. The Mini-Mental State Examination（MMSE）, trail-making test and grooved pegboard test were used to access cognitive function 24 hours before surgery and 4, 8, 12, 24 hours after surgery. Results There was no significant differences between the values of rS（O2） of the three groups in perioperative period, with P〉0.05, and the MMSE scores 4, 8 and 12 hours after operation were statistically lower than those measured when the patients entered the operation room, with P〈0.05. Trial-making test and grooved pegboard test showed that the task completion time of group D was shortened while that of group M was prolonged. There were 3 cases（15%） in group M with congestive function changes, 2 cases（10%） in group C and one case in group D 4 hours after operation; there were 2 cases（10%） in group M, one case in group C and no one in group D with congestive function changes 8 hours after operation; there was only one case（5%） with congestive function changes in group M 12 hours after operation, with the remained ones in the three