右美托咪定对老年胸科手术患者围术期脑氧代谢和术后认知功能障碍.DOCVIP

右美托咪定对老年胸科手术患者围术期脑氧代谢和术后认知功能障碍的影响 江苏省兴化市中医院麻醉科 李鸿志 【摘要】 目的 探讨右美托咪定对老年胸科手术患者围术期脑氧代谢和术后认知功能障碍的影响。方法 拟行开胸手术老年患者80例，ASA分级I-II级，采用随机数字表法随机分为右美托咪定组（D组）和对照组（C组）。D组麻醉诱导前经静脉泵注右美托咪定0.5 ug/kg，持续20 min；随后以0.3 ug/kg/h持续泵注维持至术毕；C组以同样方法静脉输注等量生理盐水。分别于麻醉诱导前（T0）、气管插管后即刻（T1）、气管插管后30 min（T2）及手术结束时（T3）时经桡动脉和颈内静脉球部采集血样行血气分析，计算动脉－颈内静脉血氧含量差（Da-jvO2）和脑氧摄取率（CERO2）。并于术后6 h、1 d、2 d、3 d时随访，使用简易精神状态检查量表（Mini-Mental State Examination，MMSE）对患者精神状态进行评分。结果 与C组比较，D组患者Da-jvO2及CERO2在T2和T3时间点时均明显降低（P 0.05）。与术前比较，C组患者术后各时间点MMSE评分均明显降低（P 0.05），然而，D组患者仅术后6 h及术后1 d的MMES评分显著降低（P 0.05）；与C组比较，D组患者MMSE评分在术后1 d、2 d及3 d时间点时均明显升高（P 0.05）。结论 右美托咪定可以降低老年开胸手术患者围术期脑代谢，改善术后认知功能。 【关键词】 右美托咪定；心率变异；脑氧代谢；术后认知功能障碍 Effects of Dexemdetomidine on Perioperative Cerebral Oxygen Metabolism and Postoperative Cognitive Function in the Elderly Patients Undergone Thoracic Surgery Xinghua city TCM hospital Department of Anesthesiology, Jiangsu lihongzhi 【Abstract】sing the random number table method: Control group (C group) and Dexemdetomidine group (D group), and 40 patients in each group. Patients in D group were given intravenous infusion of dexemdetomidine at a dose of 0.5 ug/kg over 20 minutes before operation, followed by intravenous infusion of dexemdetomidine at a rate of 0.3 ug/kg/h until the end of operation. Patients in C group were given the equal volume of saline. Blood samples for blood gas were taken from radial artery and jugular bulb before induction of anesthesia (T0), immediately after tracheal intubation (T1), 30 minutes after tracheal intubation (T2), and at the end of operation (T3). Da-jvO2 and CERO2 were calculated at the same time. Mini-Mental State Examination score was recorded at the timepoint of 6 h and 1, 2, 3 d after operation. Results Compared with that of C group, Da-jvO2 and CERO2 was decreased in D group at the timepoints of T2 and T3 (P 0.05). Compared with preoperative score, MMSE score was decreased at all postoperative time points in C group , as well as 6 h and 1 d after operation in D gro