维持剂量右美托咪定对行腹部手术的老年全麻患者术后认知功能影响

目的 探讨维持剂量右美托咪定对行腹部手术的老年全麻患者术后认知功能的影响.方法 选取2014年5月-2016年1月接受全麻下行腹部手术的老年患者120例,按治疗方案分为观察组和对照组,每组60例.观察组麻醉诱导前10 min予以泵注右美托咪定,对照组给予等量生理盐水.观察2组认知功能、镇静效果,术前10 min、术后10 min、拔管后30 min平均动脉压(MAP)、心率、血氧饱和度(SpO2)的变化,比较2组术中全麻药物用量及苏醒情况.记录2组术后认知功能障碍(POCD)的发生情况.结果 观察组术后1、3d简易智力状态检查量表(MMSE)评分及用药后10、30 min Ramsay评分均高于对照组(P ＜0.05,P＜0.01).观察组术后10 min及拔管后30 min MAP、心率低于对照组,SpO2高于对照组(P＜0.05).观察组瑞芬太尼与丙泊酚用量少于对照组,自主呼吸恢复时间、拔管时间和定向力恢复时间短于对照组(P＜0.01);观察组POCD发生率低于对照组(P＜0.05).结论 右美托咪定用于老年患者腹部手术能够减少术中麻醉药物的用量,加快患者认知功能的恢复,降低POCD的发生率.

Influence of Maintenance Dosage Dexmedetomidine on Cognitive Function of Elderly Patients with General Anesthesia after Abdominal Operation

Objective To investigate influence of maintenance dosage Dexmedetomidine on cognitive function of elderly patients with general anesthesia after abdominal operation.Methods A total of 120 patients with general anesthesia undergoing abdominal operation during May 2014 and January 2016 were divided into observation group (n =60)and control group (n =60) according to treatment plans.Observation group was injected with Dexmedetomidine 10 minutes before anesthesia induction by pump,while control group was injected with same volume of physiological saline.In two groups,cognitive function and sedation effect were observed,and level changes of mean arterial pressure (MAP),heart rate (HR) and arterial oxygen saturation (SpO2) at 10 min before surgery,10 min after surgery and 30 min after extubation were also observed;intraoperative dosage of general anesthetics and awakening condition of two groups were compared;incidence rate of postoperative cognitive dysfunction (POCD) were recorded.Results Scores of mini-mental state examination (MMSE) at postoperative 1st d and 3rd d and Ramsay scores at 10th and 30th after medication in observation group were significantly higher than those in control group (P ＜ 0.05,P ＜ 0.01).Levels of MAP and HR were significantly lower,while SpO2 level was significantly higher at postoperative 10 min and 30 mnin after extubation in observation group than those in control group (P ＜ 0.05).In observation group,doses of Remifentanil and Propofol were less,and recovery time of spontaneous respiration,extubation time and recovery time of orientation force were shorter than those in control group (P ＜ 0.01);incidence rate of POCD was lower than that in control group (P ＜ 0.05).Conclusion Dexmedetomidine in application of elderly patients with general anesthesia during abdominal operation may decrease dosage of narcotic drug,quicken recovery of cognitive function and reduce incidence rate of POCD.