圍麻醉期右美托咪定的應(yīng)用對老年患者PFN術(shù)后認(rèn)知功能障礙的影響

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[摘要] 目的 研究圍麻醉期右美托咪定（Dex）的應(yīng)用對老年患者股骨粗隆間骨折行髓內(nèi)釘（PFN）術(shù)后認(rèn)知功能障礙（POCD）的影響。 方法 選取2018年1～12月廣州市第一人民醫(yī)院南沙醫(yī)院收治的股骨粗隆間骨折，在椎管內(nèi)麻醉下?lián)衿谛蠵FN手術(shù)的老年患者60例為研究對象，采用隨機數(shù)字表法分為Dex組（D組，n = 30）和對照組（C組，n = 30）。D組患者麻醉前15 min靜脈泵注Dex 0.3 μg/kg作為術(shù)前用藥，10 min泵注完，術(shù)中泵注Dex 0.3 μg/（kg·h）至術(shù)終，術(shù)后Dex 1 μg/（kg·d）+舒芬太尼2 μg/（kg·d）行PCIA 48 h;C組患者圍麻醉期靜脈泵注生理鹽水，術(shù)后舒芬太尼2 μg/（kg·d）行PCIA。檢測麻醉前（T0）、術(shù)后24 h（T1）、術(shù)后48 h（T2）血清丙二醛（MDA）、8-異構(gòu)前列腺素F2α（8-iso PGF2α）水平，并行簡易精神狀態(tài)評價量表（MMSE）評分。 結(jié)果 兩組患者T1、T2的MDA、8-iso PGF2α水平高于T0，但D組低于C組同時點，差異有統(tǒng)計學(xué)意義（P < 0.05）。兩組患者T1、T2的MMSE評分低于T0，但D組高于C組同時點，差異有統(tǒng)計學(xué)意義（P < 0.05）。C組T1和T2的VAS高于D組，按壓次數(shù)、有效按壓次數(shù)、舒芬太尼用量多于D組，差異有統(tǒng)計學(xué)意義（P < 0.05）。 結(jié)論 圍麻醉期應(yīng)用Dex，可降低老年患者PFN術(shù)后 POCD的發(fā)生率。

[關(guān)鍵詞] 右美托咪定;術(shù)后認(rèn)知功能障礙;圍麻醉期;丙二醛;8-異構(gòu)前列腺素F2α

[中圖分類號] R687.4? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（a）-0117-04

Effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia

YAN Yan

Department of Anesthesiology， the First People′s Hospital of Guangzhou City， Guangdong Province， Guangzhou? 510180， China

[Abstract] Objective To study the effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia. Methods Sixty elderly scheduled for PFN surgery under spinal anesthesia were enrolled in Nansha Hospital of the First People′s Hospital of Guangzhou City from January to December 2018 were selected as study objects， and they were divided into Dexmedetomidine group （group D， n = 30） and control group （Group C， n = 30） by using random numeral table method. The patients in group D were intravenous infused 0.3 μg/kg Dexmedetomidine within 10 min as premedication 15 minutes before anesthesia， followed by 0.3 μg/（kg·h） infusion until the end of operation. The patients in group C received intravenous infusion of saline. Patient-controlled intravenous analgesia （PCIA） was started for all patients when they were transferred to the ward. The patients were given Sufentanyl 2 μg/（kg·d） as PCIA 100 mL in group C. Group D were given Dexmedetomidine 1 μg/（kg·d） + Sufentanyl 2 μg/（kg·d） as PCIA 100 mL. The levels of MDA and 8-iso PGF2α in serum were detected before anesthesia （T0）， 24 h （T1） and 48 h （T2） after operation. The min-mental state examination （MMSE） scores were estimated at T0， T1 and T2. Results The levels of MDA and 8-iso PGF2α at T1 and T2 in two groups were higher than those at T0， but those in group D were lower than those in group C at the same time， the differences were statistically significant （P < 0.05）. MMSE scores of T1 and T2 in two groups were lower than those of T0， but those in group D were higher than those in group C at the same time， the differences were statistically significant （P < 0.05）. VAS of T1 and T2 in group C was higher than that in group D， and the times of pressing， effective pressing and the dosage of Sufentanil in group C were higher than those in group D， the differences were statistically significant （P < 0.05）. Conclusion Dexmedetomidine can reduce the incidence of postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia.

[Key words] Dexmedetomidine; Postoperative cognitive dysfunction; Perianesthesia; Malondialdehyde; 8-iso prostaglandin F2α

術(shù)后認(rèn)知功能障礙（POCD）是患者在術(shù)后出現(xiàn)精神活動、人格、社交活動及認(rèn)知能力的變化，65歲以上患者發(fā)病率達(dá)20%～50%[1]。在手術(shù)損傷時，往往同時發(fā)生炎癥與氧化應(yīng)激反應(yīng)，腦組織的高代謝特性，導(dǎo)致其容易遭受氧化應(yīng)激損傷，使神經(jīng)元變性、壞死或凋亡，出現(xiàn)認(rèn)知障礙[2]。鹽酸右美托咪定（Dex）有鎮(zhèn)靜、抗焦慮、降低應(yīng)激反應(yīng)的作用，本研究對股骨粗隆間骨折行髓內(nèi)釘（PFN）內(nèi)固定術(shù)的老年患者，圍麻醉期應(yīng)用Dex，探討Dex對POCD的影響。

1 資料與方法

1.1 一般資料

選取2018年1～12月廣州市第一人民醫(yī)院南沙醫(yī)院（以下簡稱“我院”）收治股骨粗隆間骨折，擇期行PFN手術(shù)的老年患者60例為研究對象，采用隨機數(shù)字表法分為Dex組（D組，n = 30）和對照組（C組，n = 30），其中男23例，女37例。……