右美托咪定对老年腹腔镜子宫切除术后认知功能的影响
发布时间：2018-08-29 12:14
【摘要】：目的:探讨右美托咪定对全凭静脉全身麻醉下行腹腔镜子宫切除的老年患者术后认知功能的影响及与S100β的相关性。方法:选择择期行腹腔镜子宫切除术的老年患者共60例,年龄介于65-70岁,ASA分级为Ⅰ--Ⅱ级,根据相关排除标准,随机进行分组,即右美托咪定组(D组)和对照组(C组)。D组在麻醉诱导前10分钟微量泵开始泵入右美托咪定,速度为0.5μg/kg,继之以0.2μg/(kg·h)速度持续泵入,于手术结束前30分钟停止泵入;C组在麻醉诱导前10分钟开始泵入相同容量的0.9%氯化钠注射液,于手术结束前30分钟停止泵入。所有手术患者均给予喉罩+全凭静脉全身麻醉。麻醉诱导使用药物为:咪达唑仑、芬太尼、依托咪酯、顺式阿曲库铵,之后插入喉罩,连接麻醉机进行机控呼吸,同时监测呼气末二氧化碳分压(PETCO2),并根据手术进程调整呼吸参数使PETCO2在40--45mm Hg。麻醉维持以微量泵持续泵入丙泊酚和瑞芬太尼,并间断推注顺式阿曲库铵维持镇静、镇痛、肌松效果。认知功能以简易智能状态量表(MMSE)进行评价,分别于术前1天和术后1天、术后3天、术后7天行简易智能状态量表(MMSE)评分,同时分别检测麻醉前和术后1天、术后2天外周静脉血血清中的S100β水平。结果:两组患者体重、年龄无统计学意义(P0.05);两组患者麻醉手术过程中生命体征平稳;对比手术时间、麻醉时间等指标的差异未见统计学意义(P0.05)。D组的术中第1小时和手术结束时血压及心率比C组低,差异有统计学意义(P0.05)。D组术中麻醉药物瑞芬太尼、芬太尼、丙泊酚和顺式阿曲库铵用量比C组用量少,差异有统计学意义(P0.05);右美托咪定组的丙泊酚、芬太尼、瑞芬太尼用量比对照组少,差异有统计意义(P0.05);右美托咪定组和对照组手术后1天S100β均升高,与麻醉前比较有统计学意义(P0.05),但右美托咪定组升高幅度比对照组低,两者之间比较,有统计学意义(P0.05),术后2天右美托咪定组的S100β即恢复正常,与术前无差异(P0.05)。而对照组术后2天S100β仍高,与术前比较有统计学意义(P0.05),与右美托咪定组比较有统计学意义(P0.05)。两组患者术前MMSE量表得分均为正常,术后3天有14例MMSE得分低于27分,诊断为POCD,占全部病例的23.3%,其中D组的有5例,组内占比为16.7%,C组有9例,组内占比为30%,术后第1天和第3天的D组较C组MMSE得分高,差异有统计学意义(P0.05)。结论:右美托咪定可降低术后POCD的发生率,可能与其可降低血清S100β水平,从而具有脑保护作用有关。右美托咪定的这一作用为减少老年患者行腹腔镜手术出现的POCD提供了一定的依据。
[Abstract]:Objective:To investigate the effect of dexmedetomidine on postoperative cognitive function in elderly patients undergoing laparoscopic hysterectomy under total intravenous general anesthesia and its correlation with S100beta.Methods:60 elderly patients with selective laparoscopic hysterectomy were selected, aged between 65 and 70, and ASA graded from I to II. Group D began pumping dexmedetomidine 10 minutes before anesthesia induction at a speed of 0.5 ug/kg, then continued pumping at a speed of 0.2 ug/kg/h, and stopped pumping 30 minutes before the end of the operation; group C began pumping 0.9% sodium chloride of the same volume 10 minutes before anesthesia induction. All patients were treated with laryngeal mask plus total intravenous general anesthesia. Anesthesia induction drugs were midazolam, fentanyl, etomidate, cis-atracurium, followed by insertion of a laryngeal mask, mechanical ventilation with an anesthesia machine, and monitoring of end-expiratory carbon dioxide partial pressure (PETCO2) according to the hand. Respiratory parameters were adjusted during the operation so that PETCO2 was continuously pumped into propofol and remifentanil with a micro pump during anesthesia maintenance, and cis-atracurium was intermittently injected to maintain sedation, analgesia and muscle relaxation. Cognitive function was assessed with the Simple Intelligence State Scale (MMSE) on the first day before operation, one day after operation, three days after operation, and seven days after operation. Results: There was no significant difference in body weight and age between the two groups (P 0.05); vital signs were stable during anesthesia operation; there was no significant difference in operation time and anesthesia time between the two groups. The blood pressure and heart rate in group D were lower than those in group C at the first hour and the end of operation (P 0.05). The dosage of remifentanil, fentanyl, propofol and cis-atracurium in group D was lower than that in group C (P 0.05). The dosage of propofol, fentanyl and remifentanil in group D was significantly lower than that in group C (P 0.05). Compared with the control group, the difference was statistically significant (P There was no difference between the two groups (P 0.05). However, the S100 beta in the control group was still high 2 days after operation, and there was significant difference between the two groups (P 0.05). The scores of MMSE in the two groups were normal before operation. The scores of MMSE in 14 cases were lower than 27 on the 3rd day after operation, accounting for 23.3% of all cases, and 5 cases in the D group. The MMSE score of group D was higher than that of group C on the first day and the third day after operation (P 0.05). Conclusion: dexmedetomidine can reduce the incidence of POCD after operation, which may be related to the decrease of serum S100 beta level and thus has cerebral protective effect. POCD provides a basis for laparoscopic surgery.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：2211174
[Abstract]:Objective:To investigate the effect of dexmedetomidine on postoperative cognitive function in elderly patients undergoing laparoscopic hysterectomy under total intravenous general anesthesia and its correlation with S100beta.Methods:60 elderly patients with selective laparoscopic hysterectomy were selected, aged between 65 and 70, and ASA graded from I to II. Group D began pumping dexmedetomidine 10 minutes before anesthesia induction at a speed of 0.5 ug/kg, then continued pumping at a speed of 0.2 ug/kg/h, and stopped pumping 30 minutes before the end of the operation; group C began pumping 0.9% sodium chloride of the same volume 10 minutes before anesthesia induction. All patients were treated with laryngeal mask plus total intravenous general anesthesia. Anesthesia induction drugs were midazolam, fentanyl, etomidate, cis-atracurium, followed by insertion of a laryngeal mask, mechanical ventilation with an anesthesia machine, and monitoring of end-expiratory carbon dioxide partial pressure (PETCO2) according to the hand. Respiratory parameters were adjusted during the operation so that PETCO2 was continuously pumped into propofol and remifentanil with a micro pump during anesthesia maintenance, and cis-atracurium was intermittently injected to maintain sedation, analgesia and muscle relaxation. Cognitive function was assessed with the Simple Intelligence State Scale (MMSE) on the first day before operation, one day after operation, three days after operation, and seven days after operation. Results: There was no significant difference in body weight and age between the two groups (P 0.05); vital signs were stable during anesthesia operation; there was no significant difference in operation time and anesthesia time between the two groups. The blood pressure and heart rate in group D were lower than those in group C at the first hour and the end of operation (P 0.05). The dosage of remifentanil, fentanyl, propofol and cis-atracurium in group D was lower than that in group C (P 0.05). The dosage of propofol, fentanyl and remifentanil in group D was significantly lower than that in group C (P 0.05). Compared with the control group, the difference was statistically significant (P There was no difference between the two groups (P 0.05). However, the S100 beta in the control group was still high 2 days after operation, and there was significant difference between the two groups (P 0.05). The scores of MMSE in the two groups were normal before operation. The scores of MMSE in 14 cases were lower than 27 on the 3rd day after operation, accounting for 23.3% of all cases, and 5 cases in the D group. The MMSE score of group D was higher than that of group C on the first day and the third day after operation (P 0.05). Conclusion: dexmedetomidine can reduce the incidence of POCD after operation, which may be related to the decrease of serum S100 beta level and thus has cerebral protective effect. POCD provides a basis for laparoscopic surgery.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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