右美托咪定对腰麻下老年患者髋关节置换术后认知功能的影响

摘要

目的：探讨右美托咪定对腰麻下老年患者髋关节置换术后认知功能障碍的影响。方法选择在腰麻下择期行髋关节置换，且ASA分级Ⅰ~Ⅲ级的老年患者40例，随机分为右美托咪定组及对照组，每组20例。右美托咪定组患者麻醉后予以右美托咪定以1μg/kg静脉注射，维持浓度为0.5μg·kg-1·h-1；对照组患者以同样方式泵注生理盐水。记录2组患者术前1 d、术后3 d、7 d MMSE评分；检测手术开始前( T0)、手术结束时( T1)、术后第3天( T2)、第7天( T3)静脉血 TNF-α、IL-6、MDA 水平。结果术前2组患者 MMSE 评分差异无统计学意义(P >0.05)，术后第 3天 2 组患者 MMSE 评分比较差异有统计学意义(P<0.05)，术后第7天2组评分恢复正常。2组患者血清TNF-α、IL-6、MDA水平在T0时差异无统计学意义(P>0.05)，对照组患者TNF-α、IL-6、MDA在T1、T2与同组T0水平相比升高明显，差异有统计学意义(P<0.05)，右美托咪定组IL-6在T1与同组T0水平相比有所下降，差异有统计学意义(P<0.05)；右美托咪定组患者T1、T2时的TNF-α、IL-6及T2时的MDA水平均低于对照组，差异有统计学意义(P<0.05)。结论静脉注射右美托咪定可以降低腰麻下老年患者髋关节置换术术后血清TNF-α、IL-6、MDA水平，减少术后认知功能障碍的发生。%Objective To investigate influence of dexmedetomidine on postoperative cognitive function in elder patients after hip re-placement surgery under spinal anesthesia. Methods Forty elderly patients with ASAⅠ~Ⅲ,undergoing hip replacement with spinal anesth-sia,were randomly divided into dexmedetomidine group( group A) and normal saline group( group B) ,with 20 patients in each group. Dexme-detomidine was given with 1 μg/kg after anesthesia and followed with 0. 5 μg·kg-1 ·h-1 in group A. The equal volume of normal saline was infused in group B. Cognitive function was evaluated before anesthesia,3 and 7 days after surgery by mini-mental state examination( MMSE) . The intraoperative concentration of TNF-α,IL-6,MDA were detected at the time of before surgery(T0),end of surgery(T1),3 days after sur-gery(T2),7 days after suegery. Results There was no significant difference in MMSE score before anesthesia between the two groups (P>0. 05). The difference of MMSE score at postoperative 3 days between two groups was statistical significance (P<0. 05). The MMSE score recovered normal in both groups 7 days later. There was no significant difference of TNF-α,IL-6,MDA concentration at T0 between two groups(P>0. 05). Compared with T0,the concentration of TNF-α,IL-6,MDA at T1,T2 in group B increased,the difference was significant. And the concentration of IL-6 at T1 in group A decreased,compared with that at T0,the difference was significant(P<0. 05). The concentra-tion of TNF-α,IL-6 at T1,T2 and MDA at T2 in group A were lower than those in group B,the difference was significant. (P<0. 05). Con-clusion Dexmedetomidine can decreased the concentration of TNF-α,IL-6,MDA,and improve the postoperative cognitive dysfunction of eld-erly patients who finished the hip replacement surgery under spinal anesthesia.