| 摘要: |
| ［摘要］ 目的 探讨右美托咪定对老年骨科手术患者脑代谢与术后认知功能的影响。方法 选择2012-01～2014-12择期行下肢骨折手术的老年患者80例，年龄65～93岁，ASAⅡ～Ⅲ级。采用双盲法分为观察组和对照组各40例，观察组术中给予右美托咪定；对照组术中给予等量0.9%氯化钠。于给药前(T0)、停药时（T1）、术毕（T2）分别采取桡动脉和颈内静脉球部血样各1 ml，行血气分析，测定颈内静脉球氧饱和度(SjvO2)并计算脑动脉-静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)，于术前、术后1 d和3 d由一名神经内科医师采用简易精神状态量表（MMSE）对患者进行检查并评分。结果 观察组T1、T2的Da-jvO2、CERO2较术前及对照组各时点显著降低（P<0.01）。两组术后发生认知功能下降10例（发生率为12.5%），其中观察组2例，对照组8例，两组比较差异有统计学意义（χ2=5.16，P<0.05）。结论 老年骨科手术患者术中使用右美托咪定，可有效提高患者术中镇静效果，提高麻醉质量，降低患者术中脑代谢水平，有效预防术后认知功能障碍发生。 |
| 关键词: 右美托咪定 腰-硬联合麻醉 脑代谢 术后认知功能障碍 |
| DOI：10.3969/j.issn.1674-3806.2016.01.11 |
| 分类号:R 614 |
| 基金项目: |
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| Effect of dexmedetomidine on postoperative cognitive dysfunction and brain metabolism in elderly patients with orthopedics operation |
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QIN Xing-long, HUANG Chun-liu
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Department of Anesthesiology, the Fifth People′s Hospital of Dongguan City, Guangdong 523900, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effects of dexmedetomidine on postoperative cognitive dyfunction and the brain metabolism in elderly patients with orthopedics operation.Methods 80 ASA physical status Ⅱ or Ⅲ patients, aged 65～93 years, were divided into two groups by the double blind method. The observation group was given dexmedetomidine during the operation(n=40) and the control group was given 0.9% sodium chloride solution(n=40). Blood sample of 1 ml was taken from the radial artery and jugular bulb respectively before administration(T0), when withdrawing drugs(T1) and after the surgery(T2) for gas analysis, oxygen saturation(SjvO2) and calculation of the cerebral arteries-venous oxygen content difference(Da-jvO2) and cerebral oxygen uptake rate(CERO2). Brief mental state examination(MMSE) was scored in each group before and 1, 3 days after the operation.Results Da-jvO2 and CERO2 were decreased in the observation group at T1 and T2 compared with those before the operation and at each point of the control group(P<0.01). Postoperative cognitive decline occurred in 10 patients(12.5%), including 2 cases in the observation group and 8 cases in the control group(χ2=5.16, P<0.05).Conclusion Dexmedetomidine can effectively improve sedation, anesthesia quality, reduce brain metabolism in elderly patients during orthopedic surgery, and thus effectively prevents the occurrence of postoperative POCD. |
| Key words: Dexmedetomidine Spinal-epidural anesthesia Brain metabolism Postoperative cognitive dysfunction |
