右美托咪定对老年患者胃肠道手术术后早期认知功能障碍的影响

摘要

目的 探讨右美托咪定对老年患者胃肠道手术早期术后认知功能障碍(postoperation cognitive dysfunction,POCD)的影响.方法 选择2016年5月至2017年5月在长沙市第四医院择期全麻下行开腹胃肠道手术的老年患者60例,采用随机数字表法分为右美托咪定组(n=30)和对照组(n=30).右美托咪定组于麻醉诱导前15分钟静脉输注右美托咪定负荷量0.4μg/kg,随后以0.2μg/(kg·h)速率静脉输注至手术结束前30分钟.对照组给予等容量、等速率的生理盐水.在用右美托咪定前5分钟(T0)、插管即刻(T1)、手术开始1小时(T2)、拔管即刻(T3)和拔管后10分钟(T4)等时间点,记录平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(percutaneous oxygen saturation,SpO2)等指标.于术前1天、术后1天、术后3天,采用简易精神状况量表(mini-mental state examination,MMSE)对患者进行神经精神功能测试,观察POCD发生率,同时采集患者静脉血检测肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)浓度.结果 与对照组相比,右美托咪定组MAP、HR及SpO2更稳定,术后1天、3天POCD发生率明显降低,血清炎症因子TNF-α、IL-6水平明显降低,差异有显著性(P<0.05).结论 右美托咪定能够降低老年患者胃肠道手术术后早期POCD的发生率,其机制可能是通过抑制炎症反应来实现的.%Objective To investigate the effect of dexmedetomidine on early postoperation cognitive dysfunction (POCD) in elderly patients after gastrointestinal surgery. Method A total of 60 elderly patients undergoing open gastrointestinal surgery under general anesthesia were selected from May 2016 to May 2017 in the Fourth Hospital of Changsha, who were randomly divided into 2 groups (n=30):Dexmedetomidine group and control group. Group dexmedetomidine received intravenous infusion of dexmedetomidine (0.4μg/kg) at 15 min before anesthesia induction, followed by intravenous infusion of dexmedetomidine at 0.2μg/(kg·h) rate until 30 min before the end of the operation. Group control received equal volume and equal rate of normal saline. The record of MAP, HR and SpO2) indicator were written at 5 min before using dexmedetomidine (T0), immediately after intubation (T1), 1 hours of operation (T2), extubation (T3) and 10 min after extubation (T4). The neuropsychological tests were performed on 1 day before the operation, 1 day and 3 days after the operation. The incidence of POCD was observed by Mini-Mental State Examination (MMSE). The venous blood was collected to detect blood tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) levels at 1 day before the surgery, 1 day and 3 days after the surgery. Result Compared with control group, the hemodynamics (MAP, HR) and SpO2more stable in dexmedetomidine group. Compared with control group, dexmedetomidine group significantly reduced the incidence of POCD, decreased the level of TNF-αand IL-6 (P<0.05). Conclusion Dexmedetomidine can reduce the incidence of early POCD after gastrointestinal surgery in elderly patients, and the possible mechanism is by inhibiting inflammatory response.