七氟烷复合右美托咪定对高龄患者开胸术后早期认知功能的影响

摘要

目的:探讨七氟烷复合右美托咪定对老年患者开胸术后早期认知功能的影响. 方法:选取本院2012年3月至2014年4月收治的择期行肺叶切除术的老年患者54例,随机分为实验组和对照组各27例,两组采取相同的诱导方法,此外实验组于麻醉诱导前给予0.5μg/kg 右美托咪定泵注15min,麻醉诱导后继续泵注右美托咪定0.5μg· kg-1 · h-1 ,同时持续吸入1%~3.0%七氟烷维持麻醉直至手术结束前约30min. 而对照组采取TCI泵入丙泊酚0.1mg· kg-1 · h-1. 观察两组术中及术后的生命体征指标、术中麻醉剂的用量、术后苏醒指标、术后不良反应发生情况并进行术后认知功能及相关的血清标志物的浓度的测定. 结果:术中麻醉剂用量实验组明显低于对照组的用量( P<0.05) ,实验组与对照组相比老年患者开胸术后早期认知功能障碍(POCD)的发生率明显降低(P<0.05),术后12h血清S-100β蛋白、细胞因子IL-6及 TNF-α含量实验组均明显低于对照组( P<0.05) ,术中及恢复期低血压和心动过缓发生率实验组明显高于对照组( P<0.05). 结论:七氟烷复合右美托咪定能够显著降低老年患者开胸术后POCD的发生,但该组合可能具有降低血压及致心动过缓的副作用,使用时需谨慎.%Objective:To explore the effect of sevoflurane combined with dexmedetomidine on postoper-ative cognitive function in elder patients after thoracotomy.Method:54 elder patients undergoing pulmonary lobectomy in our hospital from March 2012 to April 2014 were selected and randomly divided into experimen-tal group (n=27) and control group (n=27).Same induction methods were used in both groups.Experi-mental group received 15 minutes pump injection of 0.5μg/kg dexmedetomidine before anesthesia induction. After anesthesia induction, the experimental group was given pump injection of dexmedetomidine at rate of 0. 5μg· kg-1 · h-1 , and inhalation of 1%~3.0%sevoflurane was given at the same time to sustain anesthesia until 30 min before the surgery ended.The control group received Target Controlled Infusion ( TCI) of propo-fol at 0.1mg· kg-1 · h-1 .Intraoperative and postoperative vital sign indicators, intraoperative anesthetics us-age, postoperative revival indicators, postoperative occurrence of side effects of the two groups were ob-served, and the postoperative cognitive function and related serum biomarker concentration were also detec-ted.Result:The intraoperative anesthetics usage, occurrence of postoperative cognitive dysfunction (POCD) and serum level of S-100βprotein, cytokine IL-6 and TNF-α12 hours after the surgery of experimental group were obviously lower than those of control group ( all P<0.05) .Compared with control group, the oc-currence of hypotension and bradycardia in surgery and recovery phase of experimental group was clearly higher ( P<0.05) .Conclusion:Combination of sevoflurane and dexmedetomidine could significantly reduce the occurrence of POCD in elder patients after thoracotomy.However, the combination might have the side effect of leading to hypotension and bradycardia, and attention should be paid during usage.