右美托咪定对老年食管癌患者根治术后认知功能障碍的影响

发布时间：2018-05-06 06:30

本文选题：右美托咪定 + 术后认知功能障碍　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:本研究通过观察单肺通气对老年食管癌患者根治术后认知功能障碍的影响,探讨围术期持续泵注右美托咪定对患者炎性因子和脑氧代谢率的变化以及是否改善患者术后认知功能障碍。方法:选择西南医科大学附属中医院麻醉科2014年1月-2014年9月期间择期食管癌根治手术老年患者60例,年龄65~80岁,男女不限,ASA分级Ⅰ~Ⅱ级,随机分为右美托咪定实验组(D组,n=30)和生理盐水对照组(C组,n=30)两组。D组麻醉诱导前给予静脉微泵输注右美托咪定1μg/kg,输注时间15min,术中维持用静脉微泵输注0.5μg·kg·h,于手术结束前15 min停用。C组在同一时间点给予等量的生理盐水。两组患者常规给予芬太尼、丙泊酚、顺式阿曲库铵顺序麻醉诱导,在脑电双频指数下降至40时进行双腔支气管插管,插管成功后接麻醉机控制通气,模式为容量控制模式。术中静脉持续泵注丙泊酚、瑞芬太尼、阿曲库铵,1~2%七氟烷吸入维持适宜的麻醉深度(脑电双频指数在40~60之间)。术中单肺通气时间控制在2~3h,血氧饱和度95%以上。手术结束前15min停用吸入麻醉药和肌松药,接入镇痛泵并同时给予负荷剂量。术后镇痛采用100ml一次性使用自控电子输注泵,使用时间48小时。配方:D组右美托咪定0.08μg·kg·h+舒芬太尼0.04μg·kg·h+托烷司琼10 mg;C组舒芬太尼0.04μg·kg·h+托烷司琼10 mg。镇痛泵负荷剂量6 ml,背景输注速率2 ml/h,自控按压剂量2 ml,锁定时间15 min。实验观察指标:分别于手术前1天(T_0),术后第1天(T_1),术后第3天(T_2),术后第7天(T_3)测定简易精神状态量表(MMSE)评分、疼痛VAS评分和镇静Ramsay评分,同时于诱导前(T_a)、术后拔管即刻(T_b)、术后24h(T_c)、术后72h(T_d)抽取静脉血行血清IL-6和S-100β蛋白测定,并抽取颈静脉血和动脉血行血气分析,根据Fick公式计算动-静脉血氧含量差(Da-jv O2)和脑氧摄取率(CMRO_2)。结果:(1)与C组比较,D组T_1、T_2时MMSE评分明显升高(P0.05),而POCD发生率明显降低(P0.05);(2)与C组比较,D组T_b和T_c时IL-6、S-100β蛋白明显降低(P0.05);(3)与C组比较,D组T_b和T_c时动-静脉血氧含量差和脑氧代谢率明显降低(P0.05);(4)与C组比较,D组T1时镇静Ramsay评分明显升高(P0.05),D组T_1、T_2时疼痛VAS评分明显降低(P0.05),两组均未有呼吸抑制的出现。结论:(1)本研究剂量的右美托咪定可以协同镇静镇痛作用,镇静深度适宜,无呼吸抑制作用;(2)应用右美托咪定可以降低IL-6、S-100β蛋白和脑氧代谢率,降低POCD的发生率。
[Abstract]:Objective: to observe the effect of single lung ventilation on cognitive dysfunction in elderly patients with esophageal cancer after radical operation. Objective: to investigate the changes of inflammatory factors and cerebral oxygen metabolism rate in patients with dexmetomidine during perioperative period and whether to improve the cognitive dysfunction after operation. Methods: sixty elderly patients aged 65 to 80 were selected from Department of Anesthesiology, Department of Anesthesiology, affiliated Hospital of Southwest Medical University from January 2014 to September 2014. Two groups were randomly divided into two groups: dexmetomidine group (group D) and saline control group (group C). Group D was given intravenous micropump infusion of dexmetomidine 1 渭 g / kg before anesthesia induction for 15 minutes. Intraoperative maintenance of intravenous micropump infusion of 0. 5 渭 g kg h, was given to the operative knot before anesthesia induction. Group C. was given the same amount of saline at the same time point 15 min before the beam. The patients in both groups were induced by sequential anesthesia of fentanyl propofol and cis atracurium. The patients were intubated with double-lumen bronchial intubation when the bispectral index of EEG decreased to 40. After successful intubation the ventilation was controlled by anaesthesia machine and the mode was volume control mode. Intravenous infusion of propofol, remifentanil and atracurium 1 ~ 2% sevoflurane maintained an appropriate anesthetic depth (EEG bispectral index was between 40 and 60). The duration of single lung ventilation was controlled at 2 h for 3 h, and the oxygen saturation was over 95%. At the end of the operation, 15min stopped inhaling anesthetics and muscle relaxants, injected analgesic pump and given loading dose at the same time. Postoperative analgesia was performed by 100ml with a self-controlled electronic infusion pump for 48 hours. Sufentanitanil 0.08 渭 g kg h sufentanil 0.04 渭 g kg h tropisetron 10 mg / g, sufentanil 0.04 渭 g kg h tropisetron 10 mg / g. The analgesic pump loading dose was 6 ml, the background infusion rate was 2 ml / h, the self-controlled compression dose was 2 ml, and the locking time was 15 min. The experimental outcome measures: 1 day before operation, 1 day after operation, 3 days after operation, 7 days after operation. The scores of mini-mental state scale (MMSE), pain VAS score and sedative Ramsay score were measured. At the same time, before induction, immediately after the extubation of Tastasia, immediately after the extubation of TCI, 24 hours after operation, 24 hours after operation, 72 hours after operation, venous blood was taken for determination of serum IL-6 and S-100 尾 protein, and jugular vein blood and arterial blood were taken for blood gas analysis. According to the Fick formula, the difference of arterial and venous oxygen content (Da-jv O _ 2) and cerebral oxygen uptake rate were calculated. Results compared with group C, the MMSE score of group D was significantly higher than that of group C, and the incidence of POCD was significantly lower than that of group C. (compared with group C, the expression of IL-6 protein S-100 尾 in group D was significantly lower than that in group C, and the difference in blood oxygen content between group D and group C was significantly lower than that in group C and group C in T _ b and T _ c, respectively. Compared with group C, the sedative Ramsay score of group D was significantly higher than that of group C at T _ 1 and T _ 2. The VAS score of pain in group T _ (1) and T _ (2) was significantly lower than that in group C, and there was no respiratory inhibition in both groups. Conclusion: the dose of dexmetomidine in this study can cooperate with sedative analgesia, the depth of sedation is suitable, and there is no effect of respiratory inhibition. Dexmetomidine can reduce the level of IL-6 S-100 尾 protein and cerebral oxygen metabolism, and reduce the incidence of POCD.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.1

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