天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (6): 663-665.doi: 10.11958/j.issn.0253-9896.2015.06.023

• 药物临床观察 • 上一篇    下一篇

右美托咪定对老年人髋部手术后认知功能障碍的影响

张云飞， 高伟忠， 马世颖， 刘金碧   

  1. 遵义市第一人民医院麻醉科
  • 收稿日期:2014-10-09 修回日期:2015-01-22 出版日期:2015-06-15 发布日期:2015-06-10
  • 通讯作者: 张云飞 E-mail:zhangyf9229@163.com
  • 基金资助:
    基金名称：遵义市科学技术局联合科技研发资金项目

Dexmedetomidine on cognitive function of elderly patients who underwent hip orthopedic#br# surgery

ZHANG Yunfei,GAO Weizhong, MA Shiying,LIU Jinbi   

  1. Department of Anesthesiology, the First People’ s Hospital of Zunyi
  • Received:2014-10-09 Revised:2015-01-22 Published:2015-06-15 Online:2015-06-10
  • Contact: zhangyunfei E-mail:zhangyf9229@163.com

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摘要： 目的 观察硬膜外麻醉复合不同剂量右美托咪定对老年人髋部手术后循环和认知功能障碍 （POCD） 的影响。方法 选择 2013 年 6 月—2014 年 9 月，65 岁以上髋部手术患者 120 例， 行硬膜外麻醉联合右美托咪定静脉泵注， 按右美托咪定的泵注量不同， 分为 A 组 0.2 μg·h-1·kg-1， B 组 0.4 μg·h-1·kg-1和 C 组 0.6 μg·h-1·kg-1， 每组 40 例。观察并记录 3 组患者入室时 （T0）、 用药后 10 min （T1）、 用药后 20 min （T2）、 停药即刻 （T3）、 停药后 10 min （T4） 以及手术完毕时（T5）的心率（HR）、 平均动脉压（MAP）、 血氧饱和度（SpO2）。应用简易智力状态量表（MMSE）测试 3 组患者术前 24 h（t1）、 术后 12 h（t2）、 术后 24 h（t3）及术后 72 h（t4）认知功能。结果 3 组患者在 T0时 MAP、 HR 及 SpO2比较差异无统计学意义； C 组 T2、 T3时 HR 和 MAP 均较 A 组、 B 组明显下降 （均 P < 0.05）。3 组术前 MMSE 评分差异无统计学意义， B 组 t2、 t3时的 MMSE 评分均明显高于 A 组和 C 组（P < 0.05）； B 组 POCD 发生率明显低于 A 组和 C 组（P <0.05）。结论 硬膜外麻醉复合右美托咪定以 0.4 μg·h-1·kg-1静脉泵注对老年患者的循环干扰小， 可减少老年患者围手术期认知功能障碍的发生。

关键词: 麻醉, 硬膜外, 认知障碍, 手术后期间, 老年人, 右美托咪定

Abstract: Abstract Objective To observe the effect of a variety of dexmedetomidine on circulatory and cognitive functions in elderly patients undergoing hip orthopedic surgery. Methods A total of 120 cases for hip orthopedic surgery, aged over 65 years old and recruited from 06/2013 to 09/2014, were administered intravenously dexmedetomidin -e after epidural anesthesia. Based on the various doses of dexmedetomidine, the patients were randomly and averagely divided into 3 groups, including group A of 0.2 μg?h-1?kg-1, group B of 0.4 μg?h-1?kg-1, and group C of 0.6 μg?h-1?kg-1, with 40 cases in each group. The heart rate (HR)，mean arteria1 pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at 6 time points, including the time of admission to the operating room(T0), 10 min (T1), 20 min (T2) after drug administration, the time of drug withdrawal (T3), 10 min after drug withdrawal (T4) and the terminal time of surgery (T5), respectively. Cognitive function was evaluated by mini-mental state examination (MMSE) at the time points of 24 hours before surgery (t1), 12 hours (t2), 24 hours (t3), and 72 hours (t4) after surgery. Results there was no significant difference of the general status among the 3 group (P > 0. 05). A significant decrease in MAP and HR at T2 and T3 time point was observed in group C compared to that in group A or group B (P < 0.05). There was no significant difference in MMSE at time point t0 among the three groups (P > 0.05). However, compared to that in group A or group C, MMSE increased significantly at time point t2, t3 in group B (P< 0.05). In addition, compared to group A or group C, the patients in group B exhibited lower incidence of postoperative cognitive function disorder(POCD) (P<0.05)。 Conclusion Continuous intravenous pumping of Dexmedetomidine can be used in elderly patient undergoing hip orthopedic surgery with the dose of 0.4 μg?h-1?kg-1 safely, with less interference to circulatory and cognitive function in perioperative period.

Key words: anesthesia, epidural, cognition disorder, postoperative period, aged, Dexmedetomidine