發(fā)布時(shí)間：2018-08-29 12:14

【摘要】：目的:探討右美托咪定對(duì)全憑靜脈全身麻醉下行腹腔鏡子宮切除的老年患者術(shù)后認(rèn)知功能的影響及與S100β的相關(guān)性。方法:選擇擇期行腹腔鏡子宮切除術(shù)的老年患者共60例,年齡介于65-70歲,ASA分級(jí)為Ⅰ--Ⅱ級(jí),根據(jù)相關(guān)排除標(biāo)準(zhǔn),隨機(jī)進(jìn)行分組,即右美托咪定組(D組)和對(duì)照組(C組)。D組在麻醉誘導(dǎo)前10分鐘微量泵開始泵入右美托咪定,速度為0.5μg/kg,繼之以0.2μg/(kg·h)速度持續(xù)泵入,于手術(shù)結(jié)束前30分鐘停止泵入;C組在麻醉誘導(dǎo)前10分鐘開始泵入相同容量的0.9%氯化鈉注射液,于手術(shù)結(jié)束前30分鐘停止泵入。所有手術(shù)患者均給予喉罩+全憑靜脈全身麻醉。麻醉誘導(dǎo)使用藥物為:咪達(dá)唑侖、芬太尼、依托咪酯、順式阿曲庫(kù)銨,之后插入喉罩,連接麻醉機(jī)進(jìn)行機(jī)控呼吸,同時(shí)監(jiān)測(cè)呼氣末二氧化碳分壓(PETCO2),并根據(jù)手術(shù)進(jìn)程調(diào)整呼吸參數(shù)使PETCO2在40--45mm Hg。麻醉維持以微量泵持續(xù)泵入丙泊酚和瑞芬太尼,并間斷推注順式阿曲庫(kù)銨維持鎮(zhèn)靜、鎮(zhèn)痛、肌松效果。認(rèn)知功能以簡(jiǎn)易智能狀態(tài)量表(MMSE)進(jìn)行評(píng)價(jià),分別于術(shù)前1天和術(shù)后1天、術(shù)后3天、術(shù)后7天行簡(jiǎn)易智能狀態(tài)量表(MMSE)評(píng)分,同時(shí)分別檢測(cè)麻醉前和術(shù)后1天、術(shù)后2天外周靜脈血血清中的S100β水平。結(jié)果:兩組患者體重、年齡無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者麻醉手術(shù)過(guò)程中生命體征平穩(wěn);對(duì)比手術(shù)時(shí)間、麻醉時(shí)間等指標(biāo)的差異未見(jiàn)統(tǒng)計(jì)學(xué)意義(P0.05)。D組的術(shù)中第1小時(shí)和手術(shù)結(jié)束時(shí)血壓及心率比C組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。D組術(shù)中麻醉藥物瑞芬太尼、芬太尼、丙泊酚和順式阿曲庫(kù)銨用量比C組用量少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);右美托咪定組的丙泊酚、芬太尼、瑞芬太尼用量比對(duì)照組少,差異有統(tǒng)計(jì)意義(P0.05);右美托咪定組和對(duì)照組手術(shù)后1天S100β均升高,與麻醉前比較有統(tǒng)計(jì)學(xué)意義(P0.05),但右美托咪定組升高幅度比對(duì)照組低,兩者之間比較,有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后2天右美托咪定組的S100β即恢復(fù)正常,與術(shù)前無(wú)差異(P0.05)。而對(duì)照組術(shù)后2天S100β仍高,與術(shù)前比較有統(tǒng)計(jì)學(xué)意義(P0.05),與右美托咪定組比較有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)前MMSE量表得分均為正常,術(shù)后3天有14例MMSE得分低于27分,診斷為POCD,占全部病例的23.3%,其中D組的有5例,組內(nèi)占比為16.7%,C組有9例,組內(nèi)占比為30%,術(shù)后第1天和第3天的D組較C組MMSE得分高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:右美托咪定可降低術(shù)后POCD的發(fā)生率,可能與其可降低血清S100β水平,從而具有腦保護(hù)作用有關(guān)。右美托咪定的這一作用為減少老年患者行腹腔鏡手術(shù)出現(xiàn)的POCD提供了一定的依據(jù)。
[Abstract]:Objective:To investigate the effect of dexmedetomidine on postoperative cognitive function in elderly patients undergoing laparoscopic hysterectomy under total intravenous general anesthesia and its correlation with S100beta.Methods:60 elderly patients with selective laparoscopic hysterectomy were selected, aged between 65 and 70, and ASA graded from I to II. Group D began pumping dexmedetomidine 10 minutes before anesthesia induction at a speed of 0.5 ug/kg, then continued pumping at a speed of 0.2 ug/kg/h, and stopped pumping 30 minutes before the end of the operation; group C began pumping 0.9% sodium chloride of the same volume 10 minutes before anesthesia induction. All patients were treated with laryngeal mask plus total intravenous general anesthesia. Anesthesia induction drugs were midazolam, fentanyl, etomidate, cis-atracurium, followed by insertion of a laryngeal mask, mechanical ventilation with an anesthesia machine, and monitoring of end-expiratory carbon dioxide partial pressure (PETCO2) according to the hand. Respiratory parameters were adjusted during the operation so that PETCO2 was continuously pumped into propofol and remifentanil with a micro pump during anesthesia maintenance, and cis-atracurium was intermittently injected to maintain sedation, analgesia and muscle relaxation. Cognitive function was assessed with the Simple Intelligence State Scale (MMSE) on the first day before operation, one day after operation, three days after operation, and seven days after operation. Results: There was no significant difference in body weight and age between the two groups (P 0.05); vital signs were stable during anesthesia operation; there was no significant difference in operation time and anesthesia time between the two groups. The blood pressure and heart rate in group D were lower than those in group C at the first hour and the end of operation (P 0.05). The dosage of remifentanil, fentanyl, propofol and cis-atracurium in group D was lower than that in group C (P 0.05). The dosage of propofol, fentanyl and remifentanil in group D was significantly lower than that in group C (P 0.05). Compared with the control group, the difference was statistically significant (P There was no difference between the two groups (P 0.05). However, the S100 beta in the control group was still high 2 days after operation, and there was significant difference between the two groups (P 0.05). The scores of MMSE in the two groups were normal before operation. The scores of MMSE in 14 cases were lower than 27 on the 3rd day after operation, accounting for 23.3% of all cases, and 5 cases in the D group. The MMSE score of group D was higher than that of group C on the first day and the third day after operation (P 0.05). Conclusion: dexmedetomidine can reduce the incidence of POCD after operation, which may be related to the decrease of serum S100 beta level and thus has cerebral protective effect. POCD provides a basis for laparoscopic surgery.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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