摘要
目的:考察右美托咪定对老年患者腰椎术全麻镇痛及术后认知功能的影响。方法:64例行腰椎手术的患者按随机数字表法分为观察组和对照组,各32例。两组患者均常规给予芬太尼及顺式阿曲库铵进行麻醉诱导,观察组患者于麻醉诱导前后加用右美托咪定静脉注射,对照组患者给予等量0.9%氯化钠注射液静脉注射。分别于术前(T0)、手术开始2 h(T1)、术后24 h(T2)测定患者血清中肾上腺糖皮质激素的浓度;采用疼痛视觉模拟评分法(VAS)对患者术后2、8、24 h的疼痛状态进行评定;采用简易智能精神状态量表(MMSE)对患者术后1、2 d的认知状态进行评估,计算患者术后认知功能障碍(POCD)发生率;观察患者不良反应发生情况。结果:观察组患者在T1时肾上腺糖皮质激素的浓度明显低于对照组,差异有统计学意义(P<0.05);观察组患者术后2h的VAS评分明显低于对照组,差异有统计学意义(P<0.05),但术后8、24 h的VAS评分与对照组比较差异无统计学意义(P>0.05);观察组患者术后1、3 d的POCD发生率明显低于对照组,差异有统计学意义(P<0.05)。术后两组患者均未见除POCD以外的麻醉相关不良反应。结论:右美托咪定有较强的抗氧化能力,能有效减轻老年患者腰椎手术过程中的氧化应激,降低其术后POCD的发生率。
OBJECTIVE：To study the effects of dexmedetomidine on general anesthesia analgesia of lumbar spinal surgery and postoperative cognitive function in elderly patients. METHODS：64 patients underwent lumbar spinal surgery were randomly divided into observation group and control group with 32 cases in each group. Both group were routinely given fentanyl and cisatracurium for anesthesia induction;observation group was additional given intravenous injection of dexmedetomidine before and after anesthesia induction;control group was additionally given same volume of 0.9% sodium chloride injection with intravenous injection.The serum concentration of adrenocortical hormone was detected before surgery（T0）,2 h after surgery began（T1）,24 h after surgery（T2）;VAS was used for analgesic effect evaluation 2,8 and 24 h after surgery;MMSE was used to evaluate cognitive function 1 and 2 d after operation,and the incidence of POCD was calculated. The occurrence of ADR was observed. RESULTS：The serum concentration of adrenocortical hormone in observation group was significantly lower than in control group at T1,with statistical significance（P〈0.05）. VAS score of observation group 2 h after surgery were significantly lower than that of control group,with statistical significance（P〈0.05）;there was no statistical significance in VAS score 8 and 24 h after surgery（P〉0.05）;the incidence of POCD in observation group was significantly lower than in control group 1 and 3 d after surgery,with statistical significance（P〈0.05）. No anesthesia-related ADR was found except POCD. CONCLUSIONS：Dexmedetomidine has strong antioxidant capacity,can effectively reduce oxidative stress in elderly patients during lumbar spinal surgery,and reduce the incidence of POCD.
出处
《中国药房》
CAS
北大核心
2016年第11期1521-1523,共3页
China Pharmacy
基金
承德市科学技术研究与发展计划项目(No.20142057)
关键词
右美托咪定
镇痛
术后认知功能障碍
老年患者
腰椎手术
Dexmedetomidine
Analgesia
Postoperative cognitive dysfunction
Elderly patients
Lumbar spinal surgery
