右美托咪定联合控制性低中心静脉压对肝肿瘤切除术患者术后认知功能影响

摘要

目的 探讨右美托咪定联合控制性低中心静脉压对肝叶肿瘤切除患者术后认知功能的影响.方法 选择2016年1月至2017年6月于湖北民族学院附属民大医院择期行肝叶肿瘤切除手术术患者80例(ASAⅠ~Ⅲ级),按随机数表法分为正常中心静脉压组(C组)、控制性低中心静脉压组(LCVP组)、右美托咪定组(Dex组)和右美托咪定+控制性低中心静脉压组(Dex+LCVP组),每组20例.C组采用传统液体管理方法,术中将中心静脉压(CVP)维持于正常水平(6~12 cmH2O);LCVP组术中严格控制液体输注速度,联合血管活性药物将CVP控制在0~5 cmH2O;Dex组在C组基础上持续泵入右美托咪定;Dex+LCVP组术中采用低中心静脉压联合持续泵入右美托咪定注射液.记录患者术中一般情况,并用简易智能状态检查量表(MMSE)分别评估四组患者在术前1 d(T1)、术毕1 h(T2)、术后1 d(T3)、术后3 d(T4)、术后7 d(T5)各时间点的认知功能评分,并于上述时刻抽取外周静脉血离心后采用ELISA法测定血浆白介素-6(IL-6)、S-100β蛋白浓度.结果 四组患者的一般资料及手术时间比较差异均无统计学意义(P>0.05);LCVP组、Dex+LCVP组较C组、Dex组出血量和术中输血量明显减低,差异均有统计学意义(P<0.05);四组患者T2、T3、T4时的MMSE评分较T1时明显减低,差异均有统计学意义(P<0.05);T2、T3、T4时间点Dex组、Dex+LCVP组的MMSE评分均较C组高,差异均有统计学意义(P<0.05);四组患者血浆IL-6、S-100β浓度在T2时间点均较术前T1升高,差异均有统计学意义(P<0.05);与C组比较,LCVP组、Dex组、Dex+LCVP组患者的血浆IL-6浓度在T2、T3时间点明显减少,差异均有统计学意义(P<0.05);与C组比较,LCVP组、Dex组、Dex+LCVP组患者血浆S-100β浓度在T3、T4时间点明显减少,差异均有统计学意义(P<0.05).结论 右美托咪定联合控制性低中心静脉压应用于肝肿瘤切除术可明显改善患者术后认知功能,值得临床进一步研究以推广应用.%Objective To explore the effects of dexmedetomidine combined with controlled low central venous pressure(CLCVP)on postoperative cognitive dysfunction of liver cancer patients.Methods A total of 80 cases(ASAⅠ~Ⅲ)of patients undergoing liver resection for cancer,who admitted to the Affiliated Hospital of Hubei Institute for Nationalities during the period of January 2016 and June 2017,were selected and divided into four groups according to random number table, with 20 cases in each group: the normal central venous pressure group (group C), the control group of low central venous pressure (group LCVP), the dexmedetomidine (group Dex), the dexmedetomidine+con-trolled low central venous pressure group(group Dex+LCVP).During the operation,the group C was managed with the traditional liquid method,and the central venous pressure was maintained to the normal level(6-12 cmH2O).The group LCVP strictly controlled the liquid infusion speed and used drugs to remain CVP at 0-5 cmH2O.The group Dex em-ployed intraoperative continuous pumping with dexmedetomidine,and the group Dex+LCVP was conducted with dex-medetomidine and the technology of LCVP.The general information of patients,score of mini-mental state examination (MMSE)were recorded at preoperative 1 day(T1),postoperative 1 hour(T2),1 day(T3),3 days(T4),and 7 days(T5). At the moment,peripheral venous blood samples was detected with enzyme-linked immunosorbent assay(ELISA)meth-od to determine the plasma concentration of IL-6,S-100β.Results There was no significant difference in the opera-tion time between the four groups in our study(P>0.05).The amount of blood loss and blood transfusion in the group LCVP and group Dex+LCVP were significantly lower than those in group C and group Dex (P<0.05). The score of MMSE in the four groups at T1 were significantly lower than those at T2,T3,T4(P<0.05).At the same time,the scores in the groups Dex and Dex+LCVP were significantly higher than those in group C at T2,T3,T4(P<0.05).The concentra-tions of IL-6 and S-100β in plasma in the four groups at T2 were significantly higher than that at T1(P<0.05).At T2, T3,the concentrations of IL-6 in the groups Dex and Dex+LCVP were significantly lower than those in the group C (P<0.05).The concentrations of S-100β in plasma in the groups LCVP,Dex,Dex+LCVP at T3,T4 was significant lower than those in the group C(P<0.05).Conclusion Dexmedetomidine combined with LCVP can significantly improve the postoperative cognitive function in the patients with liver tumors,which deserves further research and application in clin-ic widely.