右美托咪定复合依托咪酯对全麻的老年患者术后认知功能障碍的影响(1)
【摘要】 目的 探究右美托咪定復合依托咪酯对全身麻醉(全麻)的老年患者术后认知功能障碍(POCD)的影响。方法 90例全麻腹部手术患者， 随机分为右美托咪定组(D组)、依托咪酯组(E组)和右美托咪定复合依托咪酯组(DE组)，各30例。记录术前1 d(T0)、手术开始前(T1)、手术结束(T2)、麻醉停止后患者意识恢复时(T3)， 拔管前即刻(T4)、拔管后即刻(T5)、拔管后3 min(T6)、拔管后5 min(T7)、术后1及3 d的心率(HR)、平均动脉动压(MAP)和血氧饱和度(SpO2)。于术前1 d及术后1、3 d采用简易精神状态检查表(MMSE)评定患者认知状态。结果 D组和DE组T1～T7、术后1及3 d的MAP和SpO2与T0比较差异具有统计学意义(P<0.05)。D组和DE组T0～T7的MAP与E组比较差异具有统计学意义(P<0.05)。D组和DE组T1～T4的HR与E组比较差异具有统计学意义(P<0.05)。D组T0、T5、T6的SpO2与E组比较差异具有统计学意义(P<0.05)；DE组T3、T4、T6、T7、术后3 d的SpO2与E组比较差异具有统计学意义(P<0.05)。三组患者自主呼吸恢复时间、苏醒时间、清醒拔管时间比较差异无统计学意义(P>0.05)。E组术后1 d MMSE评分为(24.4±1.1)分， 明显低于D组的(26.1±2.9)分和DE组(26.0±2.7)分， 差异有统计学意义(P<0.05)。结论 右美托咪定复合依托咪酯使患者围术期血压稳定， 降低术后炎症因子水平， 减少其术后认知功能障碍的发生。
【关键词】 右美托咪定；依托咪酯；老年患者；术后认知功能障碍
DOI：10.14163/j.cnki.11-5547/r.2017.22.001
【Abstract】 Objective To investigate the effect of dexmedetomidine combined with etomidate on postoperative cognitive dysfunction (POCD) in general anesthesia elderly patients. Methods A total of 90 general anesthesia abdominal surgery patients were randomly divided into dexmedetomidine group (group D)， etomidate group (group E) and combination of dexmedetomidine and etomidate group (group DE)， with 30 cases in each group. Record were made on heart rate (HR)， mean arterial pressure (MAP) and degree of blood oxygen saturation (SpO2) at 1 d before operation (T0)， before operation (T1)， the end of operation (T2)， consciousness recovery time after the cessation of anesthesia (T3)， immediately before extubation (T4)， immediately after extubation (T5)， 3 min after extubation (T6)， 5 min after extubation (T7). The cognitive status of patients was assessed by mini mental state checklist (MMSE) at 1 day before operation and 1 day after operation. Results Group D and group DE had statistically significant difference in MAP and SpO2 at T1～T7 and 1 and 3 d after operation than at T0 (P<0.05). Group D and group DE had statistically significant difference in MAP at T0～T7 than group E (P<0.05). Group D and group DE had statistically significant difference in HR at T1～T4 comparing with group E (P<0.05). Group D had statistically significant difference in SpO2 at T0， T5 and T6 comparing with group E (P<0.05). Group DE had statistically significant difference in SpO2 at T3， T4， T6， T7 and 3 d after operation comparing with group E (P<0.05). Three groups had no statistically significant difference in spontaneous breathing recovery time， wake up time and sober extubation time (P>0.05). Group E had obviously lower MMSE score in postoperative 1 d as (24.4±1.1) points than (26.1±2.9) points in group D and (26.0±2.7) points in group DE. Their difference had statistical significance (P<0.05). Conclusion Combination of dexmedetomidine and etomidate can stable perioperative blood pressure， lower postoperative inflammatory factor levels and reduce the occurrence of postoperative cognitive dysfunction., 百拇医药(李琳 杨旭芳 芦相玉)
【关键词】 右美托咪定；依托咪酯；老年患者；术后认知功能障碍
DOI：10.14163/j.cnki.11-5547/r.2017.22.001
【Abstract】 Objective To investigate the effect of dexmedetomidine combined with etomidate on postoperative cognitive dysfunction (POCD) in general anesthesia elderly patients. Methods A total of 90 general anesthesia abdominal surgery patients were randomly divided into dexmedetomidine group (group D)， etomidate group (group E) and combination of dexmedetomidine and etomidate group (group DE)， with 30 cases in each group. Record were made on heart rate (HR)， mean arterial pressure (MAP) and degree of blood oxygen saturation (SpO2) at 1 d before operation (T0)， before operation (T1)， the end of operation (T2)， consciousness recovery time after the cessation of anesthesia (T3)， immediately before extubation (T4)， immediately after extubation (T5)， 3 min after extubation (T6)， 5 min after extubation (T7). The cognitive status of patients was assessed by mini mental state checklist (MMSE) at 1 day before operation and 1 day after operation. Results Group D and group DE had statistically significant difference in MAP and SpO2 at T1～T7 and 1 and 3 d after operation than at T0 (P<0.05). Group D and group DE had statistically significant difference in MAP at T0～T7 than group E (P<0.05). Group D and group DE had statistically significant difference in HR at T1～T4 comparing with group E (P<0.05). Group D had statistically significant difference in SpO2 at T0， T5 and T6 comparing with group E (P<0.05). Group DE had statistically significant difference in SpO2 at T3， T4， T6， T7 and 3 d after operation comparing with group E (P<0.05). Three groups had no statistically significant difference in spontaneous breathing recovery time， wake up time and sober extubation time (P>0.05). Group E had obviously lower MMSE score in postoperative 1 d as (24.4±1.1) points than (26.1±2.9) points in group D and (26.0±2.7) points in group DE. Their difference had statistical significance (P<0.05). Conclusion Combination of dexmedetomidine and etomidate can stable perioperative blood pressure， lower postoperative inflammatory factor levels and reduce the occurrence of postoperative cognitive dysfunction., 百拇医药(李琳 杨旭芳 芦相玉)