Objective To investigate the protective effect of dexmedetomidine on cognitive function in elderly patients after operation.Methods Totally 120 elderly patients from January 2012 to June 2014 receiving non cardiac surgery were enrolled and randomly divided into control group and dexmedetomidine group (each 60 cases).In both groups,midazolam,sufentanil,etomidate and vecuronium were used for anesthesia induction;remifentanil,propofol and cisatratracurium besilate were intravenously infused during surgery.In dexmedetomidine group,before anesthesia induction,dexmedetomidine was intravenously infused [loading dose of 40 μg,dripping for 10-15 min,then 13 μg/(kg · h),continuing to the end of operation].The doses of remifentanil,propofol and cisatratracurium besilate were recorded;the minimum mental state examination (MMSE) scores before,1,3 and 7 d after operation were assessed;the incidence of postoperative cognitive dysfunction was compared between the two groups.Results No significant fluctuation of blood pressure and severe sinus bradycardia occurred in both groups.The doses of remifentanil,propofol and cisatratracurium besilate in dexmedetomidine group were all significantly lower than those in control group [(1.12 ±0.14) mg vs (1.71 ±0.22) mg,(207 ± 179) mg vs (306 ± 215) mg,(19 ±4) mg vs (26±4) mg] (all P ＜0.05).One day after operation,no significant difference of MMSE score was found between control group and dexmedetomidine group (P ＞ 0.05);3 and 7 days after operation,MMSE score in dexmedetomidine group was higher than that in control group [(27.0 ± 2.3) scores vs (23.0 ± 3.1) scores,(27.3 ± 2.2) scores vs (25.5 ± 2.5) scores] (both P ＜ 0.05).In dexmedetomidine group,the incidence of postoperative cognitive dysfunction was significantly lower than that in control group [6.7％ (4/60) vs 25.0％ (15/60)] (P ＜ 0.05).Conclusion Dexmedetomidine can significantly reduce the amount of narcotic drugs during operation and protect postoperative cognitive function in elderly patients.%目的 探讨右美托咪定对老年患者术后认知功能的保护作用.方法 纳入2012年1月至2014年6月重庆市大足区人民医院老年肠道手术患者120例,完全随机将患者分为对照组和右美托咪定组,各60例.对照组采用咪达唑仑、舒芬太尼、依托咪酯和维库溴铵进行麻醉诱导,手术过程中根据麻醉需要静脉滴注瑞芬太尼、丙泊酚和顺苯磺酸阿曲库铵;右美托咪定组麻醉过程与对照组相同,另于麻醉诱导前,静脉滴注右美托咪定,负荷剂量40μg,滴注时间10 ～15 min,后以1～3 μg/(kg·h)速率持续至术毕.比较2组患者瑞芬太尼、丙泊酚、顺苯磺酸阿曲库铵应用总剂量,评估并比较2组患者术后1、3、7d简易精神状态量表(MMSE)评分及术后认知功能障碍发生率.结果 2组患者手术过程中均未出现血压明显波动和严重窦性心动过缓.右美托咪定组瑞芬太尼、丙泊酚、顺苯磺酸阿曲库铵总剂量,均明显低于对照组[(1.12 ±0.14)mg比(1.71 ±0.22) mg、(207±179) mg比(306±215) mg、(19 ±4) mg比(26 ±4)mg,均P＜0.05];右美托咪定组和对照组术后1 d MMSE评分差异无统计学意义(P＞0.05),右美托咪定组术后3、7 d MMSE评分高于对照组[(27.0±2.3)分比(23.0±3.1)、(27.3±2.2)分比(25.5±2.5)分,均P＜0.05].右美托咪定组术后认知功能障碍发生率低于对照组[6.7％(4/60)比25.0％ (15/60)],差异有统计学意义(P＜0.05).结论 右美托咪定可明显减少术中麻醉药物用量,对老年患者术后认知功能具有保护作用.
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