右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响
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摘要
目的:探讨右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响。方法:选取择期在全麻行开腹妇科手术、血红蛋白8～9 g/dl的患者30例,ASA分级Ⅰ～Ⅱ级,将其随机分成两组:生理盐水组(N组)和右美托咪啶组(D组),每组15例。两组麻醉诱导后,均行七氟醚复合瑞芬太尼静吸复合麻醉维持。D组在麻醉诱导前经15 min静脉输注右美托咪定0.5μg/kg,继之以0.3μg·kg~(-1)·h~(-1)的速率输注至术毕,N组给予等容量生理盐水。分别于入室时(T_0)、吸氧后3 min(T_1)、手术开始即刻(T_2)、手术开始后10 min(T_3)、20 min(T_4)、30 min (T_5)、手术结束即刻(T_6)以及患者苏醒拔管后5 min(T_7)记录平均动脉压(Mean Arterial Pressure,MAP)、心率(Heart Rate,HR)、血氧饱和度(Percutaneous Oxygen Saturation,SpO_2)、呼吸末二氧化碳分压(End-Tidal Carbon DioxidePartial Pressure,PETCO_2)、脑氧饱和度(Regional Cerebral Saturation Of Oxygenation,rSO_2)、脑电双频指数(Bispectral Index,BIS)以及腋温。并于术前1 d、术后1 d以及术后3 d,记录蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)数值以及术后认知功能障碍(Postoperative Cognitive Dysfunction,POCD)的发生率。结果:与N组比较,D组在T_2～T_6时的rSO_2升高,HR降低(P<0.05),两组各时点MAP、SpO_2、PETCO_2、BIS以及腋温比较差异无统计学意义(P>0.05)。与N组比较,D组术后1天、术后3天MoCA评分均显著升高,且术后认知功能障碍的发生率明显降低(P<0.05)。结论:右美托咪定能够提高低血红蛋白患者的脑氧饱和度,改善患者脑氧供需平衡,降低术后认知功能障碍的发生率。
Objective: To investigate the effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function ofpatients with low hemoglobin. Methods: Thirty female patients, with hemoglobin concentration of 8-9 g/dl, aged 50-65 yr,weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective gynecologic operation were randomly divided into 2 groups(n = 15 each) using a random number table: normal saline group(group N) and dexmedetomidine group(group D). After anesthesia induction the two groups all underwent sevoflurane and remifentanil intravenous-inhalation combined anesthesia, patients in group D were given dexmedetomidine infused intravenously at a dose of 0.5 μg/kg over 15 min, before induction of anesthesia, followed by 0.3 μg·kg~(-1)·h~(-1) infusion until the end of surgery, patients in group N were given an equivalent amount of normal saline infusion. Before induction of anesthesia(baseline,T_0), at 3 min after the oxygen inhalation(T_1), at immediately and 10 min,20 min, 30 min after the start of the operation(T_(2-5)), at the end of the operation(T_6), and at 5 min after extubation(T_7), the mean arterial pressure(MAP), heart rate(HR), percutaneous oxygen saturation(SPO_2), end-tidal carbon dioxide partial pressure(PETCO_2), cerebral oxygen saturation(rSO_2), bispectral index(BIS), body temperature were recorded. At 1 day before the start of the operation, at 1 day, 3 day after the operation the score of Montreal Cognitive Assessment(MoCA), and the incidence of postoperative cognitive dysfunction(POCD) were also recorded. Results: Compared with group N, the rSO_2 was significantly increased, the HR was decreased at the time point of T_2～T_6 in group D(P<0.05). There was no significant difference in the comparison of MAP, SpO_2, PETCO_2, BIS and axillary temperature between the two groups(P>0.05). Compared with group N, the score of MoCA at 1 day, 3 day after the operation was higher,and the incidence of POCD was lower in group D(P<0.05). Conclusions: Dexmedetomidine can improve the cerebral oxygen saturation in patients with low hemoglobin, as well as improving the cerebral oxygen balance, and reduce the incidence rate of POCD of patients with low hemoglobin.
Objective: To investigate the effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function ofpatients with low hemoglobin. Methods: Thirty female patients, with hemoglobin concentration of 8-9 g/dl, aged 50-65 yr,weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective gynecologic operation were randomly divided into 2 groups(n = 15 each) using a random number table: normal saline group(group N) and dexmedetomidine group(group D). After anesthesia induction the two groups all underwent sevoflurane and remifentanil intravenous-inhalation combined anesthesia, patients in group D were given dexmedetomidine infused intravenously at a dose of 0.5 μg/kg over 15 min, before induction of anesthesia, followed by 0.3 μg·kg~(-1)·h~(-1) infusion until the end of surgery, patients in group N were given an equivalent amount of normal saline infusion. Before induction of anesthesia(baseline,T_0), at 3 min after the oxygen inhalation(T_1), at immediately and 10 min,20 min, 30 min after the start of the operation(T_(2-5)), at the end of the operation(T_6), and at 5 min after extubation(T_7), the mean arterial pressure(MAP), heart rate(HR), percutaneous oxygen saturation(SPO_2), end-tidal carbon dioxide partial pressure(PETCO_2), cerebral oxygen saturation(rSO_2), bispectral index(BIS), body temperature were recorded. At 1 day before the start of the operation, at 1 day, 3 day after the operation the score of Montreal Cognitive Assessment(MoCA), and the incidence of postoperative cognitive dysfunction(POCD) were also recorded. Results: Compared with group N, the rSO_2 was significantly increased, the HR was decreased at the time point of T_2～T_6 in group D(P<0.05). There was no significant difference in the comparison of MAP, SpO_2, PETCO_2, BIS and axillary temperature between the two groups(P>0.05). Compared with group N, the score of MoCA at 1 day, 3 day after the operation was higher,and the incidence of POCD was lower in group D(P<0.05). Conclusions: Dexmedetomidine can improve the cerebral oxygen saturation in patients with low hemoglobin, as well as improving the cerebral oxygen balance, and reduce the incidence rate of POCD of patients with low hemoglobin.
引文
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[2]Moerman A,Meert F,De Hert S.Cerebral near-infrared spectroscopy in the care of patients during cardiological procedures:a summary of the clinicalevidence[J].J Clin Monit Comput,2016,30(6):901-909
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[10]韦秋凤,陈小健,冯丝丝,等.右美托咪定对全髋关节置换术患者脑氧代谢与能量代谢的影响[J].广西医科大学学报,2017,34(5):743-745Wei Qiu-feng,Chen Xiao-jian,Feng Si-si,et al.Effect of dexmedetomidine on cerebral oxygen metabolism and energy metabolism in patients underwent total hip replacement[J].Journal of Guangxi Medical University,2017,34(5):743-745
[11]Abdul-Khaliq H,Troitzsch D,Berger F,et al.Regional transcranial oximetry with near infrared spectroscopy(NIRS)in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation[J].Biomed Tech(Berl),2000,45(11):328-332
[12]刘珊珊,李恩有.脑氧饱和度监测在老年患者中的应用进展[J].中华临床医师杂志(电子版),2013,7(24):11798-11800Liu Shan-shan,Li En-you.The application of monitoring cerebral oxygen saturation in elderly patients[J].Chin J Clin(Electronic Edition),2013,7(24):11798-11800
[13]Heena Bidd,Audrey Tan,David Green.Using bispectral index and cerebral oximetry to guide hemodynamic therapy in high-risk surgical patients[J].Perioperative Medicine,2013,2(1):11
[14]Henrik S?rensen,Hilary P.Grocott,Niels H.Secher.Near infrared spectroscopy for frontal lobe oxygenation during non-vascular abdominal surgery[J].Clin Physiol Funct Imaging,2016,36:427-435
[15]Panzera P,Greco L,Carravetta G,et al.Alteration of brain oxygenation during“piggy back”liver transplantation[J].Adv Exp Med Biol,2006,578:269-275
[16]Moerman A,De Hert S.Cerebral oximetry:the standard monitor of the future?[J].Curr Opin Anaesthesiol,2015,28(6):703-709
[17]Torella F,Cowley R,Thorniley MS,et al.Monitoring blood loss with near infrared spectroscopy[J].Comp Biochem Physiol A Mol Integr Physiol,2002,132:199-203
[18]Torella F,Cowley RD,Thorniley MS,et al.Regional tissue oxygenation during hemorrhage:can near infrared spectroscopy be used to monitor blood loss[J].Shock,2002,18(5):440-444
[19]Lassnigg A,Hiesmayr M,Keznickl P,et al.Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy:effects of hemodilution,temperature,and flow[J].JCardiothorac Vasc Anesth,1999,13(5):544-548
[20]Liem KD,Hopman JC,Oeseburg B,et al.The effect of blood transfusion and haemodilution on cerebral oxygenation and haemodynamics in newborn infants investigated by near infrared spectrophotometry[J].Eur J Pediatr,1997,156(4):305-310
[21]吕安庆,陈文迪.右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系[J].河北医科大学学报,2012,33(3):299-303Lv An-qing,Chen Wen-di.Relations the cerebral oxygen metabolism and the cognitive function after combined dexmedetomidine anesthesia operation in elderly patients[J].Journal of Hebei medical university,2012,33(3):299-303
[22]Maria Wujtewicz1,Dariusz Maciejewski,Hanna Misio覥ek.Use of dexmedetomidine in the adult intensive care unit[J].Anaesthesiology Intensive Therapy,2013,45(4):235-240
[23]Oak Z.Chi,Christine Hunter,Xia Liu.et al.The Effects of Dexmedetomidine on Regional Cerebral Blood Flow and Oxygen Consumption During Severe Hemorrhagic Hypotension in Rats[J].Anesth Analg,2011,113(2):349-355
[24]王准,边卫,寇党培,等.右美托咪啶对体外循环心内直视手术患者脑氧代谢和糖代谢的影响[J].中华麻醉学杂志,2011,31(11):1293-1297Wang Huai,Bian Wei,Kou Dang-pei,et al.Effects of dexmedetomidine On cerebral oxygen and glucose metabolism in patients undergoing mitral valve replacement under cardiopulmonary bypass[J].Chin J Anesthesiol,2011,31(11):1293-1297
[25]Ebert TJ,Hall JE,Barney JA.The Effects of Increasing Plasma Concentrations of Dexmedetomidine in Humans[J].Anesthesiology,2000,93(2):382-394
[26]杨延超,朱俊超.不同剂量右美托咪定对全麻患者镇静效果和血流动力学的影响[J].中国冶金工业医学杂志,2013,30(2):202-205Yang Yan-chao,Zhu Jun-chao.Effects of different doses of dexmedetomidine on the sedative efficacy and haemodynamics during general anesthesia[J].Chinese Medical Journal of Metallurgical Industry,2013,30(2):202-205
[27]Kishi K,Kawaguchi M,Yoshitani K et al.Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers[J].JNeurosurg Anesthesiol,2003,15(4):302-306
[28]贾宝森,张宏.脑氧饱和度监测在临床的应用进展[J].武警医学,2004,15(10):781-783Jia Bao-sen,Zhang Hong.The progress about Monitoring of cerebral oxygen saturation in clinical application[J].Medical Journal of the Chinese People's Armed Police Forces,2004,15(10):781-783
[29]Jun IG,Shin WJ,Park YS,et al.Factors affecting intraoperative changes in regional cerebral oxygen saturation in patients undergoing liver transplantation[J].Transplant Proc,2013,45(1):245-250
[2]Moerman A,Meert F,De Hert S.Cerebral near-infrared spectroscopy in the care of patients during cardiological procedures:a summary of the clinicalevidence[J].J Clin Monit Comput,2016,30(6):901-909
[3]Ni C,Xu T,Li N,et a1.Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperativecognitive dysfunction[J].BMC Anesthesiol,2015,15:156
[4]Zheng F,Sheinberg R,Yee M,et a1.Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients.A systematic review[J].Anesth Analg,2013,116(3):663-676
[5]K.Yoshitani,M.Kawaguchi,M.Iwata.Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of hemoglobin concentration under propofol and sevoflurane anaesthesia[J].British Journal of Anaesthesia,2005,94(3):341-346
[6]占丽芳,李国强,单热爱,等.右美托咪定对脑幕上肿瘤切除术患者脑氧代谢的影响[J].广东医学,2014,35(22):3481-3484Zhan Li-fang,Li Guo-qiang,Shan Re-ai,et al.Effects of dexmedetomidine on cerebral oxygen metabolism during supratentorial tumor resection[J].Guangdong Medical Journal,2014,35(22):3481-3484
[7]Jian Lu,Gang Chen,Hongmei Zhou,et al.Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy:Arandomized double blinded controlled trial[J].J Clin Anesth,2017,41:30-34
[8]张光辉,马文泽,王虹,等.右美托咪定对颅内动脉瘤栓塞术患者围术期脑氧代谢的影响[J].中国卫生产业,2013,19:102-104Zhang Guang-hui,Ma Wen-ze,Wang Hong,et al.Effects of dexmedetomidine on cerebral oxygen metabolism during operation period in patients undergoing embolization of intracranial aneurysm[J].China Health Industry,2013,19:102-104
[9]邓晰明,邹琪,段立彬,等.右美托咪定对重型颅脑外伤术后脑氧代谢的影响[J].中山大学学报(医学科学版),2016,37(4):630-636Deng Xi-ming,Zou Qo,Duan Li-bin,et al.Effects on cerebral oxygen metabolism of severe traumatic brain injury after operation treated with dexmedetomidine[J].Journal of Sun Yat-Sen University(Medical Sciences),2016,37(4):630-636
[10]韦秋凤,陈小健,冯丝丝,等.右美托咪定对全髋关节置换术患者脑氧代谢与能量代谢的影响[J].广西医科大学学报,2017,34(5):743-745Wei Qiu-feng,Chen Xiao-jian,Feng Si-si,et al.Effect of dexmedetomidine on cerebral oxygen metabolism and energy metabolism in patients underwent total hip replacement[J].Journal of Guangxi Medical University,2017,34(5):743-745
[11]Abdul-Khaliq H,Troitzsch D,Berger F,et al.Regional transcranial oximetry with near infrared spectroscopy(NIRS)in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation[J].Biomed Tech(Berl),2000,45(11):328-332
[12]刘珊珊,李恩有.脑氧饱和度监测在老年患者中的应用进展[J].中华临床医师杂志(电子版),2013,7(24):11798-11800Liu Shan-shan,Li En-you.The application of monitoring cerebral oxygen saturation in elderly patients[J].Chin J Clin(Electronic Edition),2013,7(24):11798-11800
[13]Heena Bidd,Audrey Tan,David Green.Using bispectral index and cerebral oximetry to guide hemodynamic therapy in high-risk surgical patients[J].Perioperative Medicine,2013,2(1):11
[14]Henrik S?rensen,Hilary P.Grocott,Niels H.Secher.Near infrared spectroscopy for frontal lobe oxygenation during non-vascular abdominal surgery[J].Clin Physiol Funct Imaging,2016,36:427-435
[15]Panzera P,Greco L,Carravetta G,et al.Alteration of brain oxygenation during“piggy back”liver transplantation[J].Adv Exp Med Biol,2006,578:269-275
[16]Moerman A,De Hert S.Cerebral oximetry:the standard monitor of the future?[J].Curr Opin Anaesthesiol,2015,28(6):703-709
[17]Torella F,Cowley R,Thorniley MS,et al.Monitoring blood loss with near infrared spectroscopy[J].Comp Biochem Physiol A Mol Integr Physiol,2002,132:199-203
[18]Torella F,Cowley RD,Thorniley MS,et al.Regional tissue oxygenation during hemorrhage:can near infrared spectroscopy be used to monitor blood loss[J].Shock,2002,18(5):440-444
[19]Lassnigg A,Hiesmayr M,Keznickl P,et al.Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy:effects of hemodilution,temperature,and flow[J].JCardiothorac Vasc Anesth,1999,13(5):544-548
[20]Liem KD,Hopman JC,Oeseburg B,et al.The effect of blood transfusion and haemodilution on cerebral oxygenation and haemodynamics in newborn infants investigated by near infrared spectrophotometry[J].Eur J Pediatr,1997,156(4):305-310
[21]吕安庆,陈文迪.右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系[J].河北医科大学学报,2012,33(3):299-303Lv An-qing,Chen Wen-di.Relations the cerebral oxygen metabolism and the cognitive function after combined dexmedetomidine anesthesia operation in elderly patients[J].Journal of Hebei medical university,2012,33(3):299-303
[22]Maria Wujtewicz1,Dariusz Maciejewski,Hanna Misio覥ek.Use of dexmedetomidine in the adult intensive care unit[J].Anaesthesiology Intensive Therapy,2013,45(4):235-240
[23]Oak Z.Chi,Christine Hunter,Xia Liu.et al.The Effects of Dexmedetomidine on Regional Cerebral Blood Flow and Oxygen Consumption During Severe Hemorrhagic Hypotension in Rats[J].Anesth Analg,2011,113(2):349-355
[24]王准,边卫,寇党培,等.右美托咪啶对体外循环心内直视手术患者脑氧代谢和糖代谢的影响[J].中华麻醉学杂志,2011,31(11):1293-1297Wang Huai,Bian Wei,Kou Dang-pei,et al.Effects of dexmedetomidine On cerebral oxygen and glucose metabolism in patients undergoing mitral valve replacement under cardiopulmonary bypass[J].Chin J Anesthesiol,2011,31(11):1293-1297
[25]Ebert TJ,Hall JE,Barney JA.The Effects of Increasing Plasma Concentrations of Dexmedetomidine in Humans[J].Anesthesiology,2000,93(2):382-394
[26]杨延超,朱俊超.不同剂量右美托咪定对全麻患者镇静效果和血流动力学的影响[J].中国冶金工业医学杂志,2013,30(2):202-205Yang Yan-chao,Zhu Jun-chao.Effects of different doses of dexmedetomidine on the sedative efficacy and haemodynamics during general anesthesia[J].Chinese Medical Journal of Metallurgical Industry,2013,30(2):202-205
[27]Kishi K,Kawaguchi M,Yoshitani K et al.Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers[J].JNeurosurg Anesthesiol,2003,15(4):302-306
[28]贾宝森,张宏.脑氧饱和度监测在临床的应用进展[J].武警医学,2004,15(10):781-783Jia Bao-sen,Zhang Hong.The progress about Monitoring of cerebral oxygen saturation in clinical application[J].Medical Journal of the Chinese People's Armed Police Forces,2004,15(10):781-783
[29]Jun IG,Shin WJ,Park YS,et al.Factors affecting intraoperative changes in regional cerebral oxygen saturation in patients undergoing liver transplantation[J].Transplant Proc,2013,45(1):245-250