摘要
目的探讨不同剂量右美托咪定对老年剖腹手术患者炎症反应及认知功能的影响。方法将167例择期行胃肠道剖腹手术的老年患者按随机数表法分为低剂量组(42例)、中剂量组(43例)、高剂量组(41例)和对照组(41例),麻醉诱导前分别将0.25、0.50、1.00μg/kg负荷量的右美托咪定(质量浓度为0.9%的氯化钠注射液稀释至20 ml)10 min内静脉输注,随后分别以0.25、0.50、1.00μg/(kg·h)持续泵注至手术结束前30 min,对照组给予等量质量浓度为0.9%的氯化钠注射液。分别于给药前(T_0)、气管插管拔除时(T_1)、术后6 h(T_2)、术后24 h(T_3)、术后48 h(T_4)、术后72 h(T_5)利用ELISA法检测血浆中IL-1β、IL-6、TNF-α和s IL-2R浓度,分别于T_0、T_3、T_5时利用简易精神状态检查量表(MMSE)评价各组患者术后认知功能(POCD)。结果 4组患者T_1~T_5时血清IL-1β、IL-6、TNF-α和s IL-2R水平比较:高剂量组<中剂量组<低剂量组<对照组,差异有统计学意义(P<0.05);高剂量组和中剂量组T_3和T_5时MMSE评分均高于低剂量组和对照组(P<0.05),高剂量组、中剂量组和低剂量组患者POCD发生率均低于对照组(P<0.05),4组患者POCD发生率比较,差异无统计学意义(P>0.05)。结论不同剂量的右美托咪定均可改善老年剖腹手术患者术后认知功能,减少POCD的发生,中高剂量右美托咪定对防治POCD更有效,其机制可能与抑制炎症反应水平有关。
Objective To investigate the effects of different doses of dexmedetomidine on inflammatory response and cognitive function in elderly patients undergoing laparotomy. Methods One hundred and sixty-seven cases of elderly patients undergoing gastrointestinal laparotomy were randomly divided into low dose group（ 42 cases）,middle dose group（ 43 cases）,high dose group（ 41 cases） and control group（ 41 cases）. Before anesthesia induction,patients in four groups were given 0. 25,0. 50,1. 00 μg/kg dexmedetomidine（ diluted to 20 ml saline） within 10 min,respectively,followed with 0. 25,0. 50,1. 00μg/（ kg·h）,respectively,continued to pump until 30 min before the end of surgery. Before administration（ T0）,tracheal intubation（ T1）,6 h after operation（ T2）,24 h after operation（ T3）,48 h after operation（ T4） and 72 h after operation（ T5）,the levels of IL-1β,IL-6,TNF-α and s IL-2 R in plasma were measured by ELISA. At T0,T3 and T5,the cognitive function in each group was evaluated by the simple mental state examination scale（ MMSE）. Results Compared on the serum levels of IL-1β,IL-6,TNF-α and s IL-2 R at T1- T5 among the four groups： high dose group middle dose group low dose group control group,the differences were statistically significant（ P〈0. 05）. The MMSE scores at T3 and T5 in high dose group and middle dose group were higher than low dose group and control group（ P〈0. 05）. The incidence rates of POCD in high dose group,middle dose group and low dose group were lower than that in control group（ P〈0. 05）. There was no difference in the incidence rates of POCD among four groups（ P〉0. 05）. Conclusion Different doses of dexmedetomidine could improve the postoperative cognitive function in elderly patients undergoing laparotomy,reduce the occurrence of POCD. High dose of dexmedetomidine showed an obvious effect on POCD. The mechanism might be related to inhibition the level of inflammation.
作者
徐惠平
Xu Huiping(Department of Anesthesiology,Traditional Chinese Medicine Hospital of Lingbao,Sanmenxia 472500,China)
出处
《河南医学研究》
CAS
2018年第12期2133-2136,共4页
Henan Medical Research
关键词
右美托咪定
老年
剖腹手术
炎症反应
认知功能
dexmedetomidine
elderly
laparotomy
inflammatory response
cognitive function
