【摘要】：目的：探討在老年患者腹腔鏡直腸癌根治術(shù)中應(yīng)用右美托咪定對術(shù)后早期認(rèn)知障礙及炎癥反應(yīng)的影響。 方法：將40例擇期進(jìn)行腹腔鏡直腸癌根治術(shù)的老年患者（＞65歲）隨機(jī)分為右美托咪定組（D組，n=20）和生理鹽水對照組(N組,n=20)。所有患者均在全憑靜脈麻醉下完成手術(shù)，D組患者誘導(dǎo)前15min內(nèi)持續(xù)泵注右美托咪定1ug/kg，，術(shù)中以0.2~0.5ug/kg/h的速度持續(xù)泵注，直到手術(shù)結(jié)束前30min停止；N組患者給予同等劑量的0.9%生理鹽水。術(shù)中常規(guī)監(jiān)測ECG、BP、HR、SpO2和PetCO2。分別于麻醉前（T0）、插管后5min（T1）、開氣腹后20min（T2）、手術(shù)結(jié)束時（T3）、拔管后5min（T4）記錄兩組患者的平均動脈壓和心率；記錄兩組患者術(shù)中失血量、補(bǔ)液量、麻醉藥用量及手術(shù)時間；應(yīng)用簡易精神狀態(tài)量表分別測定兩組患者術(shù)前1天、術(shù)后1天及術(shù)后7天的認(rèn)知功能并統(tǒng)計(jì)POCD發(fā)病率；并于麻醉前、手術(shù)結(jié)束時、術(shù)后24h三點(diǎn)處取靜脈血，測定血清腫瘤壞死因子α（tumor necrosis factor-α，TNF-α）濃度。 結(jié)果：術(shù)前兩組患者一般狀況無統(tǒng)計(jì)學(xué)差異性。D組患者術(shù)中應(yīng)用異丙酚及瑞芬太尼的總量明顯減少N組，差異有統(tǒng)計(jì)學(xué)意義（P0.05），D組在插管后、開氣腹后血壓、心率波動較小（P0.05）。與N組相比，D組患者術(shù)后1天和術(shù)后7天的MMSE評分顯著提高，具有統(tǒng)計(jì)學(xué)差異（P0.05），而在患者術(shù)后1天和術(shù)后7天的POCD發(fā)病率上，右美托咪定組（分別為15.0%、5.0%）與對照組（分別為25.0%、15.0%）無統(tǒng)計(jì)學(xué)差異性（P0.05）。血清TNF-α測定結(jié)果顯示，兩組患者在麻醉前血清TNF-α水平比較無統(tǒng)計(jì)學(xué)差異性,而在手術(shù)結(jié)束時，N組患者血清TNF-α水平明顯降低于D組，術(shù)后24小時D組TNF-α水平低于N組，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：腹腔鏡直腸癌根治術(shù)老年患者術(shù)中應(yīng)用右美托咪定能夠改善其術(shù)后認(rèn)知功能，但未降低患者POCD的發(fā)生率，其機(jī)制與右美托咪定降低術(shù)后炎癥因子的水平有關(guān)；術(shù)中應(yīng)用右美托咪定能夠維持血流動力學(xué)平穩(wěn)，減少患者全麻期間麻醉藥用量。
[Abstract]:Objective: to investigate the effect of dexmetomidine on early postoperative cognitive impairment and inflammatory response in elderly patients undergoing laparoscopic radical resection of rectal cancer. Methods: forty elderly patients (> 65 years old) undergoing laparoscopic radical resection of rectal cancer were randomly divided into dexmetomidine group (group D, n = 20) and saline control group (group N, n = 20). All the patients were operated under total intravenous anesthesia. Before induction, the patients in group D received continuous infusion of dexmetomidine (1ug-1 / kg) into 15min before induction, and continued infusion of dexmetomidine at the speed of 0.2~0.5ug/kg/h until the end of operation. Patients in group N were given 0.9% saline at the same dose. Intraoperative routine monitoring of ECG,BP,HR,SpO2 and PetCO2. The mean arterial pressure and heart rate were recorded before anesthesia (T0), after intubation 5min (T1), after pneumoperitoneum (T2), at the end of operation (T3), and after extubation of 5min (T4). The amount of blood loss, fluid rehydration, anesthetic dosage and operation time were recorded in both groups. The cognitive function and incidence of POCD were measured 1 day before operation, 1 day after operation and 7 days after operation by simple mental state scale. Venous blood was collected at three hours after operation before anesthesia and at the end of operation. Serum tumor necrosis factor 偽 (tumor necrosis factor- 偽 (TNF- 偽) concentrations were measured. Results: there was no significant difference in general status between the two groups before operation. The total amount of propofol and remifentanil in group D was significantly decreased in group N (P0.05). The fluctuation of heart rate was small (P0.05). Compared with group N, the MMSE scores in group D were significantly higher than those in group N (P 0.05). However, the incidence of POCD in group D was significantly higher than that in group N (15.0%, P < 0.05). There was no significant difference between the control group (5.0%) and the control group (25.0%, 15.0%) (P0.05). The results of serum TNF- 偽 measurement showed that there was no significant difference in serum TNF- 偽 level between the two groups before anesthesia, but at the end of operation, the serum TNF- 偽 level in N group was significantly lower than that in D group. The level of TNF- 偽 in group D was significantly lower than that in group N 24 hours after operation (P0.05). Conclusion: the application of dexmetomidine in laparoscopic radical resection of rectal cancer can improve the postoperative cognitive function, but it does not decrease the incidence of POCD. The mechanism is related to the decrease of inflammatory factors after operation. Intraoperative use of dexmetidine can maintain hemodynamic stability and reduce anesthetic use during general anesthesia.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R735.37;R614

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