右美托咪定对军人患者术后早期认知功能的影响

目的探讨右美托咪定对军人患者术后早期认知功能的影响。方法选择拟行腹腔镜下胆囊切除术的现役军人患者60例,年龄18~44岁,ASA分级Ⅰ~Ⅱ级。将患者随机分为实验组和对照组,每组30例。实验组麻醉诱导前15 min内静脉输注右美托咪定负荷量0.8μg/kg,随后以0.4μg/（kg·h）的速率静脉输注至术毕前30 min;对照组给予等容量生理盐水。负荷量输注完毕后5 min,两组均静脉注射芬太尼3μg/kg、丙泊酚1~2 mg/kg和维库溴铵0.1 mg/kg麻醉诱导,气管插管后行机械通气。术中静脉持续泵注丙泊酚,间断注射芬太尼、维库溴铵维持麻醉,维持BIS值40～60。两组于术前1 d和术后1 d,分别进行神经心理学量表测定认知功能,采用Z计分法判断术后认知功能障碍发生率。结果术后认知功能障碍发生率,对照组为20%（6/30）,实验组为3%（1/30）;与对照组比较,实验组术后认知功能障碍发生率下降（P〈0.05）。结论右美托咪定可降低青年军人患者术后早期认知功能障碍的发生率。

Effect of dexmedetomidine on early postoperative cognitive function of soldier patients

Objective To explore the effect of dexmedetomidine on early postoperative cognitive function of soldier patients. Methods Total 60 soldiers in active service were selected to receive laparoscopic cholecystectomy. They were 18-44 years old and were divided into experiment group and control group （n = 30, respectively） ;the ASA grades included Grade Ⅰ and Ⅱ. Within 15 minutes before the induction of anesthesia, the patients in the experiment group were administered with intravenous infusion ofdexmedetomidine at a load of 0.8 μg/kg;and then,the rate of intravenous infusion was changed to 0. 4 μg/（ kg·h） till 30 minutes before the operation was completed. The control group was administered physiological saline of equal volume. After 5 minutes since the intravenous infusion was comphed, both groups were administered with intravenous infusion of fentanyl （3μg/kg）, propofol （1 ～2 mg/kg）, and vecuronium （0.1 mg/kg） for induction of anesthesia, and tracheal intubation was provided for mechanical respiration. During the operation, intravenous infusion of propofol was continued, and fentanyl and vecuronium was injected intermittently to maintain anesthesia,with the BIS value maintained between 40 and 60. One day before and after the operation, neuropsychological measuring indicator was used to determine the cognitive function of the patients in both groups, respectively, and Scoring Method Z was used to determine the incidence rate of postoperative cognitive dysfunction. Results The incidence rate of postoperative cognitive dysfunction of the patients in the control group was 20% （6/30） and that in the experiment group was 3% （1/30）. Compared with the control group,the incidence rate of postoperative cognitive dysfunction in the experiment group decreased （P 〈 0. 05 ）. Conclusion Dexmedetomidine can reduce the incidence of early postoperative cognitive dysfunction of young soldier patients.