右美托咪定对老年患者腹腔镜直肠癌根治术术后早期认知功能和炎症的影响

发布时间：2018-11-18 11:57

【摘要】：目的：探讨在老年患者腹腔镜直肠癌根治术中应用右美托咪定对术后早期认知障碍及炎症反应的影响。方法：将40例择期进行腹腔镜直肠癌根治术的老年患者（＞65岁）随机分为右美托咪定组（D组，n=20）和生理盐水对照组(N组,n=20)。所有患者均在全凭静脉麻醉下完成手术，D组患者诱导前15min内持续泵注右美托咪定1ug/kg，，术中以0.2~0.5ug/kg/h的速度持续泵注，直到手术结束前30min停止；N组患者给予同等剂量的0.9%生理盐水。术中常规监测ECG、BP、HR、SpO2和PetCO2。分别于麻醉前（T0）、插管后5min（T1）、开气腹后20min（T2）、手术结束时（T3）、拔管后5min（T4）记录两组患者的平均动脉压和心率；记录两组患者术中失血量、补液量、麻醉药用量及手术时间；应用简易精神状态量表分别测定两组患者术前1天、术后1天及术后7天的认知功能并统计POCD发病率；并于麻醉前、手术结束时、术后24h三点处取静脉血，测定血清肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）浓度。结果：术前两组患者一般状况无统计学差异性。D组患者术中应用异丙酚及瑞芬太尼的总量明显减少N组，差异有统计学意义（P0.05），D组在插管后、开气腹后血压、心率波动较小（P0.05）。与N组相比，D组患者术后1天和术后7天的MMSE评分显著提高，具有统计学差异（P0.05），而在患者术后1天和术后7天的POCD发病率上，右美托咪定组（分别为15.0%、5.0%）与对照组（分别为25.0%、15.0%）无统计学差异性（P0.05）。血清TNF-α测定结果显示，两组患者在麻醉前血清TNF-α水平比较无统计学差异性,而在手术结束时，N组患者血清TNF-α水平明显降低于D组，术后24小时D组TNF-α水平低于N组，差异具有统计学意义（P0.05）。结论：腹腔镜直肠癌根治术老年患者术中应用右美托咪定能够改善其术后认知功能，但未降低患者POCD的发生率，其机制与右美托咪定降低术后炎症因子的水平有关；术中应用右美托咪定能够维持血流动力学平稳，减少患者全麻期间麻醉药用量。
[Abstract]:Objective: to investigate the effect of dexmetomidine on early postoperative cognitive impairment and inflammatory response in elderly patients undergoing laparoscopic radical resection of rectal cancer. Methods: forty elderly patients (> 65 years old) undergoing laparoscopic radical resection of rectal cancer were randomly divided into dexmetomidine group (group D, n = 20) and saline control group (group N, n = 20). All the patients were operated under total intravenous anesthesia. Before induction, the patients in group D received continuous infusion of dexmetomidine (1ug-1 / kg) into 15min before induction, and continued infusion of dexmetomidine at the speed of 0.2~0.5ug/kg/h until the end of operation. Patients in group N were given 0.9% saline at the same dose. Intraoperative routine monitoring of ECG,BP,HR,SpO2 and PetCO2. The mean arterial pressure and heart rate were recorded before anesthesia (T0), after intubation 5min (T1), after pneumoperitoneum (T2), at the end of operation (T3), and after extubation of 5min (T4). The amount of blood loss, fluid rehydration, anesthetic dosage and operation time were recorded in both groups. The cognitive function and incidence of POCD were measured 1 day before operation, 1 day after operation and 7 days after operation by simple mental state scale. Venous blood was collected at three hours after operation before anesthesia and at the end of operation. Serum tumor necrosis factor 伪 (tumor necrosis factor- 伪 (TNF- 伪) concentrations were measured. Results: there was no significant difference in general status between the two groups before operation. The total amount of propofol and remifentanil in group D was significantly decreased in group N (P0.05). The fluctuation of heart rate was small (P0.05). Compared with group N, the MMSE scores in group D were significantly higher than those in group N (P 0.05). However, the incidence of POCD in group D was significantly higher than that in group N (15.0%, P < 0.05). There was no significant difference between the control group (5.0%) and the control group (25.0%, 15.0%) (P0.05). The results of serum TNF- 伪 measurement showed that there was no significant difference in serum TNF- 伪 level between the two groups before anesthesia, but at the end of operation, the serum TNF- 伪 level in N group was significantly lower than that in D group. The level of TNF- 伪 in group D was significantly lower than that in group N 24 hours after operation (P0.05). Conclusion: the application of dexmetomidine in laparoscopic radical resection of rectal cancer can improve the postoperative cognitive function, but it does not decrease the incidence of POCD. The mechanism is related to the decrease of inflammatory factors after operation. Intraoperative use of dexmetidine can maintain hemodynamic stability and reduce anesthetic use during general anesthesia.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37;R614

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