右美托咪啶对老年肝内胆管结石患者围术期脑功能保护作用研究*

目的 探讨右美托咪啶（Dex）对老年肝内胆管结石患者围术期脑功能的影响。方法 2017年9月~2018年6月我院诊治的72例老年肝内胆结石患者被分为对照组（n=36）和观察组（n=36）。对照组患者在麻醉诱导前给予生理盐水维持,给予观察组Dex行麻醉前处理,两组均行常规麻醉并行腹腔镜下肝叶切除术,在麻醉诱导前（T0）、取石前（T1）、取石后（T2）、术毕（T3）和术后48 h（T4）监测血氧含量（CaO2）、动脉-颈内静脉血氧含量差（Da-jvO2）和脑氧摄取率（CERO2）,采用ELLSA法检测神经元特异性烯醇化酶(NSE)和神经生化标志物S100β蛋白,常规行精神状态评价量表（MMSE）评分。结果 在术后12 h、24 h和48 h,观察组MMSE评分分别为（26.3±0.5） 分、（27.1±0.7） 分和（27.6±0.2） 分,均显著高于对照组【（24.8±0.6） 分,（25.1±0.5） 分和（25.4±0.4） 分,P<0.01】;在T1~T3时,观察组CaO2、Da-jvO2和CERO2、和血清NSE和S100β含量均显著低于对照组,差异均有统计学意义（P<0.05）;在T4时,观察组Da-jvO2为（4.6±1.2） mL/dL,CERO2为（24.8±3.3）%,血清NSE水平为（14.6±3.1） μg/L和血清S100β水平为（0.8±0.3） μg/L,均显著低于对照组【分别为（5.8±1.6） mL/dL、（33.8±3.9） %、（17.3±4.2） μg/L和（1.4±0.4） μg/L,P<0.01】。结论 Dex对老年肝内胆管结石患者围术期脑功能具有保护作用,可能与其能稳定血流动力学指标、减少血氧摄取量、降低S100β和NSE含量有关。

Protective effects of dexmedetomidine on perioperative brain function in elderly patients with intrahepatic bile duct stones

Objective To explore the effects of dexmedetomidine（Dex） on perioperative brain function in elderly patients with intrahepatic bile duct stones. Methods 72 elderly patients with intrahepatic bile duct stones were recruited in our hospital between September 2017 and June 2018,and divided into control group （n=36） and observation group（n=36）. The patients in control was given normal saline before anesthesia induction,those in observation group was given Dex. The conventional anesthesia was induced and laparoscopic hepatectomy was carried out in all the patients. The blood oxygen content（CaO2）,difference of arteriovenous blood oxygen content（Da-jvO2） and cerebral oxygen uptake rate （CERO2） were monitored before anesthesia induction （T0）,before stone removal （T1） after stone removal （T2）,at the end of surgery （T3） and at 48 h after surgery （T4）,and serum contents of neuron-specific enolase（NSE） and S100β were detected by ELISA. Mini-mental state examination （MMSE） scores were performed. Results At 12 h,24 h and 48 h after surgery,the MMSE scores were（26.3±0.5）,（27.1±0.7） and （27.6±0.2） in the observation group,much higher than （24.8±0.6）,（25.1±0.5） and （25.4±0.4）,respectively,P<0.01] in the control; at T1 to T3,the CaO2,Da-jvO2 and CERO2,and serum contents of NSE and S100β in observation group were significantly lower than those in the control group （P<0.05）;at phase T4,the Da-jvO2,CERO2 and serum contents of NSE and S100β were （4.6±1.2） mL/dL,（24.8±3.3）%,（14.6±3.1） μg/L and（0.8±0.3）μg/L in observation group,significantly lower than（5.8±1.6） mL/dL,（33.8±3.9）%,（17.3±4.2） μg/L and （1.4±0.4） μg /L,respectively,P<0.01] in the control. Conclusion s Dex has a protective effect on perioperative brain function in elderly patients with intrahepatic bile duct stones,which might be related to the stabilization of hemodynamic parameters,reduction of blood oxygen uptake and serum S100β and NSE contents.