| 王民,杨永安,耿垚,等.右美托咪定对颈内动脉剥脱术患者术后认知功能及炎性反应的影响[J].安徽医药,2016,20(4):776-779. |
| 右美托咪定对颈内动脉剥脱术患者术后认知功能及炎性反应的影响 |
| Effects of dexmedetomidine on postoperative cognitive function and inflammatory responses in patients undergoing carotid endarterectomy |
| 投稿时间：2015-10-28 |
| DOI： |
| 中文关键词: 颈内动脉剥脱术 右美托咪定 术后认知功能 炎性反应 |
| 英文关键词: carotid internal endarterectomy dexmedetomidine postoperative cognitive function inflammatory response 考文献: |
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| 中文摘要: |
| 目的 探讨右美托咪定对颈内动脉剥脱术患者术后认知功能及炎性反应的影响。方法 93例择期行全麻下单侧颈动脉内膜剥脱术患者随机分为右美托咪定组(n=47)和对照组(n=46),两组患者均采取相同的麻醉诱导和麻醉维持方法,右美托咪定组患者于麻醉诱导前,将负荷量1.0 μg·kg-1右美托咪定静脉输注10 min,气管插管后,以0.5 μg·kg-1·min-1速率静脉输注至术毕前30 min,对照组患者给予等量生理盐水静脉输注。分别于术前24 h(T0)、术后24 h(T1)、72 h(T2)和7 d(T3)时,利用简易智能量表(MMSE)对患者认知功能进行评分,分别于麻醉诱导前15 min(T01)、颈动脉夹闭20 min(T11)、颈动脉开放20 min(T21)、术后12 h(T31)和术后24 h(T41)时,利用ELISA法检测颈内静脉球部血标本中S100β、IL-6、TNF-α和脑源性神经营养因子(BDNF)浓度。结果 与T0时相比,右美托咪定组患者T1时和对照组患者T1和T2时MMSE评分降低,差异均有统计学意义(P<0.05),右美托咪定组患者T1和T2时MMSE评分均高于对照组,差异均有统计学意义(P<0.05)；右美托咪定组患者术后总POCD发生率4.3%,显著低于对照组的26.1%,差异有统计学意义(P<0.05)；右美托咪定组患者T21～41时S100β和MDA均低于对照组,T11～41时IL-6和TNF-α均低于对照组,T31～41时BDNF均高于对照组,差异均有统计学意义(P<0.05)。结论 右美托咪定可减少颈内动脉剥脱术患者术后认知功能障碍(POCD)发生,可能与增加BDNF生成有关,亦可通过抑制脑组织炎性反应而减少脑组织损失。 |
| 英文摘要: |
| Objective To investigate the effects of dexmedetomidine on postoperative cognitive function and inflammatory responses in patients undergoing carotid endarterectomy. Methods 93 cases of patients undergoing elective anesthesia unilateral carotid endarterectomy were randomly divided into dexmedetomidine group (n=47) and control group (n=46). Patients in the two groups were taken the same method of anesthesia induction and anesthesia maintenance. Before anesthesia induction, patients in dexmedetomidine group were given loading dose of 1.0 μg·kg-1 dexmedetomidine infusion 10min, after endotracheal intubation, all patients were intravenous infusion dexmedetomidine at rate of 0.5 μg·kg-1·min-1 until to before surgery 30 min. In the control group, patients were given equal volume of saline intravenous infusion. Before operation 24 h (T0), after operation 24 h (T1), 72 h (T2) and 7 d (T3), respectively, the use of simple intelligent Scale (MMSE) the scores of cognitive function in patients were evaluated by using simple intelligent Scale (MMSE). Respectively, before the induction of anesthesia 15min (T01), carotid artery occlusion 20 min (T11), the carotid artery opening 20 min (T21), after operation 12 h (T31) and after operation 24 h (T41), the levels of S100β, IL-6, TNF-α and BDNF in blood samples of jugular internal vein bulb were detected by using ELISA assay. Results Compared with T0, the scores of MMSE at T1 and T2 in the dexmedetomidine group and control group were decreased (P<0.05). The scores of MMSE at T1 and T2 in the dexmedetomidine group were higher than the control group (P<0.05).The incidence of POCD in the dexmedetomidine group was 4.3%, which was significantly lower than 26.1% in the control group (P<0.05). The levels of S100β and MDA at T21～41 in the dexmedetomidine group were lower than the control group, the levels of IL-6 and TNF-α T11～41 at were lower than the control group, the levels of BDNF at T31～41 were higher than the control group (P<0.05). Conclusions Dexmedetomidine could reduce the occurrence of POCD for carotid internal endarterectomy patients. It might be related with the generating increasing of BDNF. Also, it could reduce the loss of brain tissue by inhibiting the inflammatory response of brain tissue. |
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