标题：右美托咪定对老年患者术后认知功能及脑组织氧代谢的影响

      作者：孙静雪，毕继伟，袁琳    深圳市人民医院暨南大学第二临床医学院麻醉科，广东 深圳 518020

      卷次： 2019年30卷11期

      【摘要】 目的 探讨右美托咪定对老年手术患者脑氧代谢及术后认知功能的影响。方法 将深圳市人民医院2016年6月至2018年5月期间收治的86例接受择期全麻手术老年患者以随机数表法分为观察组和对照组，每组43例，两组患者均给予全身麻醉，观察组于麻醉诱导期给予右美托咪定，对照组同期给予生理盐水泵入，比较两组患者术后5 h、24 h、72 h的认知功能评分(MMSE)，术后24 h、72 h术后认知功能障碍(POCD)发生率，手术前后动脉血氧含量(CaO2)，颈内静脉球部血氧饱和度(SjvO2)，颈内静脉学氧含量(CjvO2)，脑氧摄取率(CERO2)和脑乳酸氧指数(LOI)。结果 术后5 h、24 h和72 h，观察组患者的MMSE评分分别为(23.6±1.6)分、(25.7±2.1)分、(28.5±2.3)分，均明显高于对照组的(20.2±1.7)分、(22.1±1.9)分、(25.4±2.2)分，差异均有统计学意义(P<0.05)；术后24 h、72 h，观察组患者的POCD发生率分别为9.3%与0，明显低于对照组的25.6%与16.3%，差异均具有统计学意义(P<0.05)；两组患者术后的CaO2、SjvO2、CjvO2、CERO2与术前比较，差异均具有统计学意义(P<0.05)；观察组患者手术前后的LOI [(0.027±0.021) vs (0.030±0.022)]比较差异无统计学意义(P>0.05)，而对照组术后LOI显著低于术前[(0.012±0.021) vs (0.028±0.022)]，差异具有统计学意义(P<0.05)；术后观察组患者的SjvO2、CjvO2、LOI分别为(63.7±4.7)%、(87.2±10.1) mL/L、0.030±0.022，明显高于对照组的(60.1±4.9)%、(82.1±10.2) mL/L、0.012±0.021，而CERO2明显低于对照组，差异均具有统计学意义(P<0.05)。结论 右美托咪定能够有效减轻老年患者术后认知功能的损伤，同时能够有效改善脑组织的氧代谢，保证脑组织氧供。
      【关键词】 右美托咪定；术后；老年；认知功能；氧代谢
      【中图分类号】 R619 【文献标识码】 A 【文章编号】 1003—6350（2019）11—1408—04

Influence of dexemdetomidine on postoperative cognitive function and cerebral oxygen metabolism in the elderlypatients undergoing surgery.
SUN Jing-xue, Bi Ji-wei, YUAN Lin. Department of Anesthesiology, Shenzhen People'sHospital (Second Clinical Medical College of Jinan University), Shenzhen 518020, Guangdong, CHINA
【Abstract】 Objective To discuss the influence of dexemdetomidine on postoperative cognitive function andcerebral oxygen metabolism in the elderly patients undergoing surgery. Methods A total of 86 elderly patients under-going general anesthesia surgery in Shenzhen People's Hospital from June 2016 to May 2018 were selected and divid-ed into the observation group (n=43) and the control group (n=43) according random number table method. All the pa-tients were given general anesthesia. The observation group was given dexmedetomidine during the induction periodof anesthesia, and the control group was given saline pump at the same time. Then the MMSE score 5 h, 25 h, and 72h after the operation, the incidence rate of postoperative cognitive dysfunction (POCD) 24 h and 72 h after the opera-tion, CaO2, SjvO2, CjvO2, CERO2, lactate oxygen index (LOI) before and after the operation were contrasted betweenthe two groups. Results Mini-mental state examination (MMSE) score 5 h, 25 h, and 72 h after the operation in the ob-servation group were 23.6±1.6, 25.7±2.1, 28.5±2.3, respectively, which were significantly higher than corresponding20.2±1.7, 22.1±1.9, 25.4±2.2 in the control group (all P<0.05). The incidence rate of COPD 24 h and 72 h after the oper-ation in the observation group were 9.3% and 0, which were significantly lower than 25.6% and 16.3% in the con-trol group (all P<0.05). There were significantly differences in CaO2, SjvO2, CjvO2, CERO2 before and after the oper-ation in the two groups (all P<0.05). There was no significantly difference in LOI before and after the operation inthe observation group: (0.027±0.021) vs (0.030±0.022), P>0.05, but LOI was significantly lower after the operationthan before in the control group: (0.012 ± 0.021) vs (0.028 ± 0.022), P<0.05. SjvO2, CjvO2, LOI were respectively(63.7±4.7)%, (87.2±10.1) mL/L, 0.030±0.022 after the operation in the observation group, which were significantlyhigher than corresponding (60.1±4.9)%, (82.1±10.2) mL/L, 0.012±0.021 in the control group (all P<0.05); but CERO2was significantly lower than the control group (P<0.05). Conclusion Dexmedetomidine can effectively alleviate thecognitive impairment of elderly patients after operation, and at the same time effectively improve the oxygen metabolismof brain and ensure the oxygen supply of brain.
      【Key words】 Dexemdetomidine; Postoperative; Elderly; Cognitive function; Cerebral oxygen metabolism