右美托咪定辅助全身麻醉对老年结直肠癌患者术后早期认知功能的影响

发布时间：2018-07-02 23:54

  本文选题：结直肠癌 + 右美托咪定　； 参考：《山东医药》2015年40期

【摘要】：目的探讨右美托咪定辅助全身麻醉对老年结直肠癌患者术后早期认知功能的影响。方法选择全身麻醉下行结直肠癌根治术的老年患者187例,按随机数字表法分为右美托咪定组93例、对照组94例。两组依次静脉注射咪唑安定0.04 mg/kg、芬太尼4μg/kg、丙泊酚0.5~1.5 mg/kg、顺阿曲库铵0.15 mg/kg进行麻醉诱导。右美托咪定组麻醉诱导前15 min静脉泵入右美托咪定1μg/kg,而后以0.2~0.6μg/(kg·h)维持泵注;对照组静脉泵注等量生理盐水。两组均采用持续静脉泵注丙泊酚1.5~2.5 mg/kg、瑞芬太尼0.04~0.4μg/(kg·min)维持麻醉深度,间断注射顺式阿曲库铵维持镇痛和肌松效果。记录两组围手术期相关指标(术中失血量、手术时间、苏醒时间)、术中麻醉镇静药物(芬太尼、瑞芬太尼、丙泊酚、咪唑安定和顺式阿曲库铵)用量等。术前1天及术后第1、3天行简易智力状态量表(MMSE)评分测定认知能力,记录术后发生认知功能障碍(POCD,MMSE≤27分)例数;采用ELISA法检测血清TNF-α、IL-6。结果两组手术时间、苏醒时间、术中出血量比较差异均无统计学意义(P均0.05),右美托咪定组麻醉镇静药物用量均少于对照组(P均0.05);术后1、3天MMSE评分均高于对照组,发生POCD例数均少于对照组(P均0.05)。两组术后1天血清TNF-α、IL-6水平较术前明显升高,对照组升高更明显(P均0.05);术后3天与术前比较无明显变化。结论右美托咪定辅助全身麻醉可减少老年结直肠癌患者术后发生POCD例数,可能与其减少术中麻醉药物用量及在创伤早期具有抗炎作用有关。
[Abstract]:Objective to investigate the effect of dexmetomidine-assisted general anesthesia on early postoperative cognitive function in elderly patients with colorectal cancer. Methods 187 elderly patients undergoing radical resection of colorectal cancer under general anesthesia were randomly divided into dexmetomidine group (n = 93) and control group (n = 94). The anesthesia was induced by intravenous injection of midazolam 0.04 mg / kg, fentanyl 4 渭 g / kg, propofol 0.5 渭 g / kg, and cisatracurium 0.15 mg/kg. The dexmetomidine group was injected intravenously with dexmetomidine 1 渭 g / kg 15 min before anesthesia induction, and then maintained with 0.2 渭 g / (kg h), while the control group received the same amount of normal saline. The anesthetic depth was maintained by intravenous infusion of propofol 1.5 to 2.5 mg / kg, remifentanil 0.04 and 0.4 渭 g / (kg min), and the analgesic and muscle relaxant effects were maintained by intermittent injection of cis atracurium. The related indexes (intraoperative blood loss, operation time, recovery time), the dosage of anesthetic sedation (fentanyl, remifentanil, propofol, midazolam and cis atracurium) were recorded. The cognitive ability was measured by MMSE score 1 day before operation and 3 days after operation, and the number of patients with postoperatively cognitive dysfunction (POCD-MMSE 鈮，

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