本文選題：結(jié)直腸癌 + 右美托咪定　； 參考：《山東醫(yī)藥》2015年40期

【摘要】：目的探討右美托咪定輔助全身麻醉對老年結(jié)直腸癌患者術(shù)后早期認(rèn)知功能的影響。方法選擇全身麻醉下行結(jié)直腸癌根治術(shù)的老年患者187例,按隨機(jī)數(shù)字表法分為右美托咪定組93例、對照組94例。兩組依次靜脈注射咪唑安定0.04 mg/kg、芬太尼4μg/kg、丙泊酚0.5~1.5 mg/kg、順阿曲庫銨0.15 mg/kg進(jìn)行麻醉誘導(dǎo)。右美托咪定組麻醉誘導(dǎo)前15 min靜脈泵入右美托咪定1μg/kg,而后以0.2~0.6μg/(kg·h)維持泵注;對照組靜脈泵注等量生理鹽水。兩組均采用持續(xù)靜脈泵注丙泊酚1.5~2.5 mg/kg、瑞芬太尼0.04~0.4μg/(kg·min)維持麻醉深度,間斷注射順式阿曲庫銨維持鎮(zhèn)痛和肌松效果。記錄兩組圍手術(shù)期相關(guān)指標(biāo)(術(shù)中失血量、手術(shù)時(shí)間、蘇醒時(shí)間)、術(shù)中麻醉鎮(zhèn)靜藥物(芬太尼、瑞芬太尼、丙泊酚、咪唑安定和順式阿曲庫銨)用量等。術(shù)前1天及術(shù)后第1、3天行簡易智力狀態(tài)量表(MMSE)評(píng)分測定認(rèn)知能力,記錄術(shù)后發(fā)生認(rèn)知功能障礙(POCD,MMSE≤27分)例數(shù);采用ELISA法檢測血清TNF-α、IL-6。結(jié)果兩組手術(shù)時(shí)間、蘇醒時(shí)間、術(shù)中出血量比較差異均無統(tǒng)計(jì)學(xué)意義(P均0.05),右美托咪定組麻醉鎮(zhèn)靜藥物用量均少于對照組(P均0.05);術(shù)后1、3天MMSE評(píng)分均高于對照組,發(fā)生POCD例數(shù)均少于對照組(P均0.05)。兩組術(shù)后1天血清TNF-α、IL-6水平較術(shù)前明顯升高,對照組升高更明顯(P均0.05);術(shù)后3天與術(shù)前比較無明顯變化。結(jié)論右美托咪定輔助全身麻醉可減少老年結(jié)直腸癌患者術(shù)后發(fā)生POCD例數(shù),可能與其減少術(shù)中麻醉藥物用量及在創(chuàng)傷早期具有抗炎作用有關(guān)。
[Abstract]:Objective to investigate the effect of dexmetomidine-assisted general anesthesia on early postoperative cognitive function in elderly patients with colorectal cancer. Methods 187 elderly patients undergoing radical resection of colorectal cancer under general anesthesia were randomly divided into dexmetomidine group (n = 93) and control group (n = 94). The anesthesia was induced by intravenous injection of midazolam 0.04 mg / kg, fentanyl 4 渭 g / kg, propofol 0.5 渭 g / kg, and cisatracurium 0.15 mg/kg. The dexmetomidine group was injected intravenously with dexmetomidine 1 渭 g / kg 15 min before anesthesia induction, and then maintained with 0.2 渭 g / (kg h), while the control group received the same amount of normal saline. The anesthetic depth was maintained by intravenous infusion of propofol 1.5 to 2.5 mg / kg, remifentanil 0.04 and 0.4 渭 g / (kg min), and the analgesic and muscle relaxant effects were maintained by intermittent injection of cis atracurium. The related indexes (intraoperative blood loss, operation time, recovery time), the dosage of anesthetic sedation (fentanyl, remifentanil, propofol, midazolam and cis atracurium) were recorded. The cognitive ability was measured by MMSE score 1 day before operation and 3 days after operation, and the number of patients with postoperatively cognitive dysfunction (POCD-MMSE 鈮，

本文編號(hào)：2091433