维持剂量右美托咪定对妇科手术全身麻醉老年患者术后认知功能的影响

摘要

目的：探讨维持剂量右美托咪定对老年妇科手术全身麻醉(简称全麻)患者术后认知功能的影响。方法选取医院2014年3月至2016年3月收治的在全麻下行妇科手术的老年患者92例，按临床特征将其分为A组和B组，各46例。两组患者均予以相同麻醉诱导及维持药物，手术开始时，A组患者给予静脉输注右美托咪定0.8μg/kg，并以0.5μg/（kg·h）的剂量维持至术毕，B组患者给予静脉等速输入等量0.9%氯化钠注射液。比较两组患者术前24 h、术毕、术后24 h、术后3 d及术后7 d的神经烯醇化酶（NSE）、白细胞介素6（IL-6）、C反应蛋白（CRP）和血清高迁移率族蛋白1（HMGB1）的水平，两组患者在上述不同时点的认知功能及认知功能障碍（POCD）发生率，以及术后不良反应发生情况。结果两组患者术毕、术后24 h、术后3 d及术后7 d的IL-6和CRP水平均较术前明显升高，且B组患者在前3个时点高于A组，差异有统计学意义（ P﹤0.05）。术毕、术后24 h及术后3 d，两组患者NSE和HMGB1水平均较术前升高，且B组升高更明显，差异有统计学意义（ P﹤0.05）；术后7 d，HMGB1水平呈下降趋势，但仍高于术前，且B组较A组高，差异有统计学意义（ P﹤0.05）。术后24 h及术后3 d，两组患者简易智能量表（MMSE )评分较术前均降低，且B组较A组降低更明显，差异有统计学意义（ P﹤0.05）。结论右美托咪定可改善行妇科手术的全麻老年患者的术后认知功能，并可有效降低术后认知功能障碍的发生率，且无明显不良反应，可作为全麻手术患者的一种麻醉辅助药物。%Objective To investigate the influence of maintenance dose DEX on postoperative cognitive function of senile patient with gen-eral anesthesia after gynecological operation. Methods 92 senile patients with general anesthesia in the hospital from March 2014 to March 2016 were selected and divided into group A and group B,46 cases in each group. The two groups were both given the same anes-thesia induction and maintenance dose. Group A was given DEX intravenous infusion 0. 8 μg/kg and maintenance dose 0. 5 μg/(kg·h). Group B was given intravenous infusion intravenous infusion. The NSE,IL-6,CRP,HMGB1,cognitive function and POCD occurrence rate at 24 h before surgery,finish time,24 h,3 d,7 d after surgery and the adverse reactions between two groups were evaluated and com-pared. Results The levels of IL-6 and CRP in two groups at finish time,24 h,3 d,7 d after surgery were higher than those at be-fore;the levels of group B at finish time,24 h,3 d after surgery was higher than those in group A,the difference was statistically sig-nificant ( P ﹤ 0. 05). The levels of NSE and HMGB1 in two groups at finish time,24 h,3 d after surgery were higher than those at before,the levels of NSE and HMGB1 of group B was higher than those in group A,the difference was statistically significant( P ﹤ 0. 05);HMGB1 declined 7 h after surgery but still higher than it at before surgery,the levels of group B was higher than it in group A, the difference of the two groups was statistically significant( P ﹤ 0. 05). The levels of MESS in two groups at 24 h,3 d after surgery was declined,it declined more obviously in group B than that in group A,the difference was statistically significant ( P ﹤ 0. 05). Conclusion DEX can improve cognitive function of senile patients with general anesthesia after gynecological operation and can lower POCD occurrence rate. No severe adverse reactions occurred after surgery. DXE can be seen as an auxiliary anesthetic drug.