右美托咪啶对老年患者心脏瓣膜置换术后脑保护作用的价值研究

摘要

Objective:To discuss the effect of dexmedetomidine on postoperative cognitive dysfunction in eld-erly patients after cardiac valve replacement,to provide theoretical reference for clinical anesthesia in elderly patients undergoing cardiac surgery.Methods:100 elderly patients who underwent cardiac valve replacement were selected and divided into two groups,50 cases each group;After anesthesia induction,the observation group was treated with dexmedetomidine to maintain the anesthetic effect,the control group was treated with equal volume of 0.9% saline infusion;Grade two groups of patients Minimum Mental State Examination(MMSE),Montreal cognitive assess-ment(MoCA)score before anesthesia and after the operation,the heart rate(HR),diastolic blood pressure(DBP), systolic pressure(SBP)of two groups of patients were observed and recorded.Results:After operation,the MMSE and MoCA scores of the two groups were lower than those before anesthesia,and reduced amplitude of the MMSE and MoCA scores of the observation group were lower than those of the control group,the difference was statistical-ly significant(P<0.05);The HR,DBP and SBP in two groups were increased before anesthesia,the difference was statistically significant(P<0.05);The HR,DBP and SBP in observation group increased significantly than the con-trol group,the difference was statistically significant(P<0.05).Conclusion:Dexmedetomidine has little effect on the central nervous system injury in elderly patients after cardiac valve replacement,the hemodynamics is stable,can protect the patient's brain,it is worth promoting for clinical anesthesia in elderly patients with heart disease.%目的:探讨右美托咪啶对老年患者心脏瓣膜置换术后认知功能障碍的影响,为老年患者心脏手术临床麻醉提供理论参考.方法:选取择期行心脏瓣膜置换术的老年患者100例,随机分成两组,每组50例;经麻醉诱导后,观察组采用右美托咪啶维持麻醉效果,对照组采用等容0.9% 生理盐水泵注;两组患者麻醉前手术后进行简易精神状态检查量表(M M SE)、蒙特利尔认知评估量表(MoCA)评分,观察两组患者心率(HR)、舒张压(DBP)、收缩压(SBP)变化情况.结果:手术后,两组患者MMSE、MoCA评分均较麻醉前降低,其中观察组MMSE、MoCA降低幅度低于对照组,差异有统计学意义(P<0.05);两组 HR、DBP、SBP均较麻醉前上升,差异有统计学意义(P<0.05);观察组HR、DBP、SBP上升幅度明显小于对照组,差异有统计学意义(P<0.05).结论:右美托咪啶对老年患者心脏瓣膜置换术后中枢神经伤害小,能促进血流动力学稳定,对患者起到脑保护作用,值得老年患者临床麻醉使用.