目的：探讨右美托咪定对老年胸科手术患者围术期脑氧代谢及术后认知功能障碍的影响。方法拟行开胸手术患者80例，年龄＞60岁，ASA分级I～II级，按随机数字表法分为右美托咪定组（ D组）和对照组（ C组）。 D组麻醉诱导前经静脉泵注右美托咪定；C组静脉泵注等量生理盐水。比较两组麻醉诱导前（ T0）、气管插管后即刻（ T1）、气管插管后30 min （ T2）及手术结束时（ T3）动脉－颈内静脉血氧含量差（ Da－jvO2）、脑氧摄取率（ CERO2）及术后6 h、1 d、2 d、3 d时简易精神状态检查量表（ mini－mental State Examination，MMSE）评分。结果 D组Da－jvO2及CERO2在T2和T3时间点时均明显低于C组，术后1、2、3 d时间点MMSE评分时均明显高于C组，差异均有统计学意义（ P ＜0．05）。 C组术后各时间点MMSE评分均明显降低（P ＜0．05），D组仅术后6 h及术后1 d显著降低（P ＜0．05）。结论右美托咪定可以降低老年开胸手术患者围术期脑氧代谢，改善术后认知功能。%Objective To explore the effects of dexemdetomidine on perioperative cerebral oxygen metabolism and postopera-tive cognitive function in the elderly patients undergone thoracic surgery.Methods Eighty ASA I~II elderly patients undergone tho-racic surgery were randomly divided into two groups using the random number table method:control group ( group C) and dexemdetomi-dine group ( group D) ,40 in each group.Patients in the group D were given intravenous infusion of dexemdetomidine before operation. Patients in the group C were given the equal volume of saline.Blood samples for blood gas were taken from radial artery and jugular bulb before induction of anesthesia ( T0 ) ,immediately after tracheal intubation ( T1 ) ,30 minutes after tracheal intubation ( T2 ) ,and at the end of operation ( T3 ) .Da-jvO2 and CERO2 were calculated at the same time.Mini-Mental State Examination score was recorded at the time point of 6 h and 1,2 and 3 d after operation.Results Compared with the group C,Da-jvO2 and CERO2 were decreased in the group D at the time points of T2 and T3(P<0.05).Compared with preoperative score,MMSE score was decreased at all postoperative time points in the group C as well as 6 h and 1 d after operation in the group D (P<0.05).Compared with the group C,MMSE score was increased at all postoperative time points in the group D ( P <0.05 ) .Conclusion Dexemdetomidine can decrease perioperative cerebral oxygen metabolism and improve postoperative cognitive function in the elderly patients undergone thoracic surgery.
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