右美托咪定对老年胸科手术患者术后认知功能的影响

目的探究右美托咪定对静脉麻醉下老年患者开胸手术后认知功能障碍的影响。方法选择择期在静脉麻醉下行开胸手术ASA分级Ⅰ~Ⅲ级老年患者80例,随机分为右美托咪定组(D组)及对照组(C组),每组40例。D组:麻醉前15min内静脉缓慢推注1μg/kg右美托咪定,维持浓度为0.5μg/(kg·h);C组以同样方式泵注等体积生理盐水。记录两组患者术前第1天,术后第3、7天简易精神状态检查表(MMSE)评分;检测手术开始前(T0)、手术结束时(T1)、术后第3天(T2)、第7天(T3)静脉血肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平。结果术前两组患者MMSE评分差异无统计学意义(P0.05),术后第3天D组MMSE评分显著高于对照组,且差异具有统计学意义(P0.05),术后第7天,两组评分恢复正常。两组患者血清TNF-α、IL-6水平在T0时,差异无统计学意义(P0.05),C组TNF-α、IL-6在T1、T2与同组T0水平相比升高明显,差异具有统计学意义(P0.05),D组IL-6在T1时与同组T0水平相比有所下降,差异具有统计学意义(P0.05);D组T1、T2时的TNF-α和IL-6水平均显著低于C组,差异具有统计学意义(P0.05)。结论右美托咪定可以降低静脉麻醉下老年患者开胸手术术后血清TNF-α、IL-6水平,及术后认知功能障碍的发生。

Influence of dexmedetomidine on postoperative cognitive function in elder patients with thoracic surgery

Objective To investigate the influence of dexmedetomidine on postoperative cognitive function in elder patients with thoracic surgery under intravenous anesthesia .Methods Eighty ASA Ⅰ - Ⅲ elderly patients with thoracic surgery under intrave‐nous anesthesia were selected and randomly divided into dexmedetomidine group (D) and control group(C) ,40 cases in each group . The group D was slowly given intravenous dexmedetomidine 1 μg/kg at 15 min before anesthesia and maintained by dexmedetomi‐dine 0 .5 μg/(kg?h) .The group C was given the equal volume of normal saline by pump infusion .The mini‐mental state examina‐tion(MMSE) score was recorded on preoperative 1 d ,postoperative 3 ,7 d .The venous serum concentration of TNF‐αand IL‐6were detected before surgery(T0) ,at the end of surgery(T1) ,on postoperative 3 ,7 d .Results The preoperative MMSE score had no statistical difference between the two groups(P>0 .05) ,but the MMSE score on postoperative 3 d in the group D was significantly higher than that in the control group ,and the difference was statistically significant(P<0 .05) ,which on postoperative 7 d in the two groups recovered to normal .The serum TNF‐α and IL‐6 concentration at T0 had no statistical difference between the two groups(P>0 .05) ,which at T1 ,T2 in the group C was significantly increased compared with that at T0 ,the difference was statisti‐cally significant(P<0 .05) ,the IL‐6 concentration at T1 in the group D was decreased compared with that at T0 ,the difference was statistically significant (P<0 .05);the concentration of TNF‐α,IL‐6 at T1 ,T2 in the group D were significantly lower than those in the group C ,the difference was statistically significant(P<0 .05) .Conclusion Dexmedetomidine can decrease the serum TNF‐αand IL‐6 levels and the occurrence of postoperative cognitive disorder in the elderly patients with thoracic surgery under intravenous an‐esthesia .