右美托咪啶对老年患者在机器人辅助腹腔镜手术麻醉苏醒期及术后认知功能的影响

发布时间：2019-03-30 22:50

【摘要】：目的:评估右美托咪啶对老年患者在机器人辅助腹腔镜前列腺癌根治术麻醉苏醒期及术后认知功能的影响。方法:择期行机器人腹腔镜下前列腺癌根治术的患者100例,年龄65~80岁,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级I~III级,随机双盲分为对照组和右美托咪啶组,每组50例。右美托咪啶组将右美托咪啶以0.8μg/(kg·h)静脉泵注10 min,再以0.3μg/(kg·h)恒速维持至手术结束前30 min;对照组给予生理盐水。气腹建立后,所有患者采用40°Trendelenberg体位。观察记录患者手术结束时(T0)、苏醒时(T1)、拔管即刻(T2)、拔管10 min(T3)四个时间点的平均动脉压、心率、脑电双频指数(bispectral index,BIS)数值;对患者进行Ramsay镇静评分、术毕舒适度评分、术后谵妄分级量表评分和VAS评分;在术前1 d,术后第1天,术后第5天通过6个认知量表评估患者记忆、注意、神经运动反应速度多领域的认知功能测试及术后认知功能障碍(postoperative cognitive dysfunction,POCD)判断;患者于术前1 d,术后1 d,术后5 d采血以检查其神经元特异性烯醇化酶(neuron specific enolase,NSE)、血清肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)和白细胞介素-6(IL-6)的含量。结果:右美托咪啶组患者在T1和T2时刻平均动脉压、心率比对照组患者降低(P0.05);与对照组比较,右美托咪啶组患者术后谵妄分级量表评分降低(P0.05)、Ramsay镇静评分升高(P0.05);术后1 d对照组17人,右美托咪啶组11人,术后5 d对照组12人,右美托咪啶组9人发生POCD;在术后1 d和术后5 d右美托咪啶组血清TNF-α,NSE,IL-6较对照组明显降低(P0.05),右美托咪啶组血清SOD较对照组明显升高(P0.05)。结论:右美托咪啶对老年患者在机器人辅助腹腔镜前列腺癌根治术麻醉苏醒期及术后有神经保护作用,其作用机制可能与右美托咪啶能减轻炎症反应有关。
[Abstract]:Aim: to evaluate the effect of right metametridine on cognitive function of elderly patients during anaesthesia and postoperative cognitive function during robot-assisted laparoscopic prostatectomy. Methods: a total of 100 patients (65-80 years old, (American Society of Anesthesiologists,ASA) were randomly divided into two groups: control group (n = 50) and right metomidine group (n = 50). The patients were randomly divided into two groups: control group (n = 50) and right metametrimidine group (n = 50). In the right metometomidine group, right metametrimidine was injected intravenously at a dose of 0.8 渭 g / (kg 路h) for 10 min, and then maintained at a constant rate of 0.3 渭 g / (kg 路h) until 30 min; before the end of the operation. After pneumoperitoneum was established, 40 掳Trendelenberg position was used in all patients. Mean arterial pressure, heart rate and bispectral index (bispectral index,BIS) were recorded at the end of operation (T0), recovery (T1), extubation immediately (T2), and extubation (10 min (T3) of the patients at the end of operation (T0), recovery (T1), extubation (T2) and extubation (T 3). The patients were assessed with Ramsay sedation score, postoperative comfort score, postoperative delirium rating scale and VAS score. On the 1st day, 1st day and 5th day after operation, 6 cognitive scales were used to evaluate the patients' memory, attention, neuromotor response speed and cognitive dysfunction (postoperative cognitive dysfunction,POCD). The serum tumor necrosis factor-伪 (TNF- 伪) and neuron-specific enolase (neuron specific enolase,NSE (Neuron-specific enolase) were measured 1 day before operation, 1 day after operation and 5 days after operation. The content of superoxide dismutase (SOD) and interleukin-6 (IL-6). Results: the mean arterial pressure and heart rate in the right metometridine group were lower than those in the control group at T1 and T2 time (P0.05). Compared with the control group, the score of postoperative delirium rating scale in the right metametrimidine group was lower (P0.05), Ramsay sedation score was higher than that in the control group (P0.05); There were 17 patients in the control group, 11 patients in the right metomidine group, 12 patients in the control group on the 5th day after operation, and 9 patients in the right metomidine group with POCD; on the 1st day after operation. On the 1st day and 5th day after operation, serum TNF- 伪 and NSE,IL-6 in right metometrimidine group were significantly lower than those in control group (P0.05), and serum SOD in right metometridine group was significantly higher than that in control group (P0.05). Conclusion: dexmetomidine has neuroprotective effect on the recovery period of anesthesia and post-operation of robot-assisted laparoscopic prostatectomy in elderly patients, the mechanism of which may be related to the reduction of inflammatory reaction by right metametrimidine.
【作者单位】：中国人民解放军总医院麻醉手术中心;中国人民解放军总医院泌尿外科;
【基金】：国家自然科学基金(30571792)~~
【分类号】：R614

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