右美托咪定对老年患者术后认知功能及脑组织氧代谢的影响
|
摘要
目的探讨右美托咪定对老年手术患者脑氧代谢及术后认知功能的影响。方法将深圳市人民医院2016年6月至2018年5月期间收治的86例接受择期全麻手术老年患者以随机数表法分为观察组和对照组,每组43例,两组患者均给予全身麻醉,观察组于麻醉诱导期给予右美托咪定,对照组同期给予生理盐水泵入,比较两组患者术后5 h、24 h、72 h的认知功能评分(MMSE),术后24 h、72 h术后认知功能障碍(POCD)发生率,手术前后动脉血氧含量(CaO_2),颈内静脉球部血氧饱和度(SjvO_2),颈内静脉学氧含量(CjvO_2),脑氧摄取率(CERO_2)和脑乳酸氧指数(LOI)。结果术后5 h、24 h和72 h,观察组患者的MMSE评分分别为(23.6±1.6)分、(25.7±2.1)分、(28.5±2.3)分,均明显高于对照组的(20.2±1.7)分、(22.1±1.9)分、(25.4±2.2)分,差异均有统计学意义(P<0.05);术后24 h、72 h,观察组患者的POCD发生率分别为9.3%与0,明显低于对照组的25.6%与16.3%,差异均具有统计学意义(P<0.05);两组患者术后的CaO_2、SjvO_2、CjvO_2、CERO_2与术前比较,差异均具有统计学意义(P<0.05);观察组患者手术前后的LOI [(0.027±0.021) vs (0.030±0.022)]比较差异无统计学意义(P>0.05),而对照组术后LOI显著低于术前[(0.012±0.021) vs (0.028±0.022)],差异具有统计学意义(P<0.05);术后观察组患者的SjvO_2、CjvO_2、LOI分别为(63.7±4.7)%、(87.2±10.1) mL/L、0.030±0.022,明显高于对照组的(60.1±4.9)%、(82.1±10.2) mL/L、0.012±0.021,而CERO_2明显低于对照组,差异均具有统计学意义(P<0.05)。结论右美托咪定能够有效减轻老年患者术后认知功能的损伤,同时能够有效改善脑组织的氧代谢,保证脑组织氧供。
Objective To discuss the influence of dexemdetomidine on postoperative cognitive function and cerebral oxygen metabolism in the elderly patients undergoing surgery. Methods A total of 86 elderly patients undergoing general anesthesia surgery in Shenzhen People's Hospital from June 2016 to May 2018 were selected and divided into the observation group(n=43) and the control group(n=43) according random number table method. All the patients were given general anesthesia. The observation group was given dexmedetomidine during the induction period of anesthesia, and the control group was given saline pump at the same time. Then the MMSE score 5 h, 25 h, and 72 h after the operation, the incidence rate of postoperative cognitive dysfunction(POCD) 24 h and 72 h after the operation, CaO_2, SjvO_2, CjvO_2, CERO_2, lactate oxygen index(LOI) before and after the operation were contrasted between the two groups. Results Mini-mental state examination(MMSE) score 5 h, 25 h, and 72 h after the operation in the observation group were 23.6 ± 1.6, 25.7 ± 2.1, 28.5 ± 2.3, respectively, which were significantly higher than corresponding20.2±1.7, 22.1±1.9, 25.4±2.2 in the control group(all P<0.05). The incidence rate of COPD 24 h and 72 h after the operation in the observation group were 9.3% and 0, which were significantly lower than 25.6% and 16.3% in the control group(all P<0.05). There were significantly differences in CaO_2, SjvO_2, CjvO_2, CERO_2 before and after the operation in the two groups(all P<0.05). There was no significantly difference in LOI before and after the operation in the observation group:(0.027±0.021) vs(0.030±0.022), P>0.05, but LOI was significantly lower after the operation than before in the control group:(0.012 ± 0.021) vs(0.028 ± 0.022), P<0.05. SjvO_2, CjvO_2, LOI were respectively(63.7 ± 4.7)%,(87.2 ± 10.1) m L/L, 0.030 ± 0.022 after the operation in the observation group, which were significantly higher than corresponding(60.1±4.9)%,(82.1±10.2) mL/L, 0.012±0.021 in the control group(all P<0.05); but CERO_2 was significantly lower than the control group(P<0.05). Conclusion Dexmedetomidine can effectively alleviate the cognitive impairment of elderly patients after operation, and at the same time effectively improve the oxygen metabolism of brain and ensure the oxygen supply of brain.
Objective To discuss the influence of dexemdetomidine on postoperative cognitive function and cerebral oxygen metabolism in the elderly patients undergoing surgery. Methods A total of 86 elderly patients undergoing general anesthesia surgery in Shenzhen People's Hospital from June 2016 to May 2018 were selected and divided into the observation group(n=43) and the control group(n=43) according random number table method. All the patients were given general anesthesia. The observation group was given dexmedetomidine during the induction period of anesthesia, and the control group was given saline pump at the same time. Then the MMSE score 5 h, 25 h, and 72 h after the operation, the incidence rate of postoperative cognitive dysfunction(POCD) 24 h and 72 h after the operation, CaO_2, SjvO_2, CjvO_2, CERO_2, lactate oxygen index(LOI) before and after the operation were contrasted between the two groups. Results Mini-mental state examination(MMSE) score 5 h, 25 h, and 72 h after the operation in the observation group were 23.6 ± 1.6, 25.7 ± 2.1, 28.5 ± 2.3, respectively, which were significantly higher than corresponding20.2±1.7, 22.1±1.9, 25.4±2.2 in the control group(all P<0.05). The incidence rate of COPD 24 h and 72 h after the operation in the observation group were 9.3% and 0, which were significantly lower than 25.6% and 16.3% in the control group(all P<0.05). There were significantly differences in CaO_2, SjvO_2, CjvO_2, CERO_2 before and after the operation in the two groups(all P<0.05). There was no significantly difference in LOI before and after the operation in the observation group:(0.027±0.021) vs(0.030±0.022), P>0.05, but LOI was significantly lower after the operation than before in the control group:(0.012 ± 0.021) vs(0.028 ± 0.022), P<0.05. SjvO_2, CjvO_2, LOI were respectively(63.7 ± 4.7)%,(87.2 ± 10.1) m L/L, 0.030 ± 0.022 after the operation in the observation group, which were significantly higher than corresponding(60.1±4.9)%,(82.1±10.2) mL/L, 0.012±0.021 in the control group(all P<0.05); but CERO_2 was significantly lower than the control group(P<0.05). Conclusion Dexmedetomidine can effectively alleviate the cognitive impairment of elderly patients after operation, and at the same time effectively improve the oxygen metabolism of brain and ensure the oxygen supply of brain.
引文
[1]马晓旭,姚永兴,侯铁宁,等.右美托咪啶用于低温射频消融辅助上气道手术的效果[J].中华麻醉学杂志,2010,30(11):1397-1398.
[2]汤龙信,丁璐,张在旺.右美托咪定的药效动力学、药代动力学及临床应用研究进展[J].临床误诊误治,2018,31(11):111-116.
[3]赵晓红,高成杰,王建,等.右美托咪定预处理减少依托咪酯所致肌阵挛的临床观察[J].山西医药杂志,2011,40(24):1220-1211.
[4]刘文奎.右美托咪定在高龄手术患者麻醉中应用的研究进展[J].现代诊断与治疗,2018,29(7):1026-1029.
[5]何敬熹,高进.影响术后认知功能障碍的麻醉药物的研究进展[J].现代药物与临床,2018,33(12):3411-3414.
[6]EL-SHMAA NS,EL-BARADEY GF.The efficacy of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation[J].J Clin Anesth,2016,31(1):267-273.
[7]张肇祺.中国老龄化社会阶段家庭医生制度的实施现状[J].河北医药,2018,40(24):3814-3817.
[8]图尔荪阿依·艾散,夏尔巴努·萨塔尔.不同麻醉方法对老年患者术后认知功能障碍的影响[J].临床合理用药杂志,2018,11(26):130-131.
[9]纪木火,雷蕾,杨建军.术后认知功能障碍研究现状[J].临床麻醉学杂志,2018,34(9):918-920.
[10]孟宏伟,吕萌.右美托咪定对胸科老年手术患者应激反应及脑氧代谢的影响[J].西北药学杂志,2017,32(6):785-788.
[11]高彦东,席俊峰,高静,等.右美托咪定联合舒芬太尼静脉自控镇痛用于食管癌患者术后镇痛的效果及对机体免疫功能的影响[J].中国药房,2018,29(24):3427-3431.
[12]樊娟,田庆荣,滕金亮,等.右美托咪定对老年脊柱手术患者围术期应激反应及术后认知的影响[J].中华老年多器官疾病杂志,2018,17(12):890-894.
[13]SUGAWARA A,HANADA S,HAYASHI K,et al.Anesthetic management using effect-site target-controlled infusion of dexmedetomidine[J].J Clin Anesth,2019,55(1):42.
[14]KITAMURA S,TAKECHI K,NISHIHARA T,et al.Effect of dexmedetomidine on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy under total intravenous anesthesia:A randomized,double blinded placebo controlled clinical trial[J].J Clin Anesth,2018,49:30-35.
[2]汤龙信,丁璐,张在旺.右美托咪定的药效动力学、药代动力学及临床应用研究进展[J].临床误诊误治,2018,31(11):111-116.
[3]赵晓红,高成杰,王建,等.右美托咪定预处理减少依托咪酯所致肌阵挛的临床观察[J].山西医药杂志,2011,40(24):1220-1211.
[4]刘文奎.右美托咪定在高龄手术患者麻醉中应用的研究进展[J].现代诊断与治疗,2018,29(7):1026-1029.
[5]何敬熹,高进.影响术后认知功能障碍的麻醉药物的研究进展[J].现代药物与临床,2018,33(12):3411-3414.
[6]EL-SHMAA NS,EL-BARADEY GF.The efficacy of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation[J].J Clin Anesth,2016,31(1):267-273.
[7]张肇祺.中国老龄化社会阶段家庭医生制度的实施现状[J].河北医药,2018,40(24):3814-3817.
[8]图尔荪阿依·艾散,夏尔巴努·萨塔尔.不同麻醉方法对老年患者术后认知功能障碍的影响[J].临床合理用药杂志,2018,11(26):130-131.
[9]纪木火,雷蕾,杨建军.术后认知功能障碍研究现状[J].临床麻醉学杂志,2018,34(9):918-920.
[10]孟宏伟,吕萌.右美托咪定对胸科老年手术患者应激反应及脑氧代谢的影响[J].西北药学杂志,2017,32(6):785-788.
[11]高彦东,席俊峰,高静,等.右美托咪定联合舒芬太尼静脉自控镇痛用于食管癌患者术后镇痛的效果及对机体免疫功能的影响[J].中国药房,2018,29(24):3427-3431.
[12]樊娟,田庆荣,滕金亮,等.右美托咪定对老年脊柱手术患者围术期应激反应及术后认知的影响[J].中华老年多器官疾病杂志,2018,17(12):890-894.
[13]SUGAWARA A,HANADA S,HAYASHI K,et al.Anesthetic management using effect-site target-controlled infusion of dexmedetomidine[J].J Clin Anesth,2019,55(1):42.
[14]KITAMURA S,TAKECHI K,NISHIHARA T,et al.Effect of dexmedetomidine on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy under total intravenous anesthesia:A randomized,double blinded placebo controlled clinical trial[J].J Clin Anesth,2018,49:30-35.