文章摘要
陈勇,宋直雷,范军朝,等.维持剂量右美托咪定对行妇科手术的全麻老年患者术后认知功能的影响[J].安徽医药,2017,21(11):2052-2056.
维持剂量右美托咪定对行妇科手术的全麻老年患者术后认知功能的影响
Influence of maintenance dose DEX on postoperative cognitive function of senile patients with general anesthesia after gynecological operation
投稿时间:2016-09-12  
DOI:
中文关键词: 维持剂量  右美托咪定  妇科手术  全麻老年患者  术后认知功能
英文关键词: Maintenance dose  DEX  Gynecological operation  Senile patients with general anesthesia  Postoperative cognitive function
基金项目:河南省医学科技攻关计划指导性计划项目(201404023)
作者单位E-mail
陈勇 河南大学第一附属医院麻醉科,河南 开封 475001  
宋直雷 河南大学第一附属医院麻醉科,河南 开封 475001  
范军朝 河南大学第一附属医院麻醉科,河南 开封 475001  
洪道先 河南大学第一附属医院麻醉科,河南 开封 475001 94403140@qq.com 
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中文摘要:
      目的 探讨维持剂量右美托咪定对行妇科手术的全麻老年患者术后认知功能的影响。方法 96例老年患者均在全麻下行妇科手术,回顾性分析患者的临床资料,根据其资料结果中的临床特征将其分为A组和B组,每组48例,两组患者均予以相同麻醉诱导及维持药物,手术开始时,A组患者予静脉输注右美托咪定0.8 μg·kg-1,并以0.5 μg·kg-1·h-1的速度维持至术毕,B组患者予静脉等速输入等量生理盐水,比较两组患者术前24 h、术毕时刻、术后24 h,3、7 d的神经烯醇化酶(NSE)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)和血清高迁移率族蛋白1(HMGB1)的水平以及两组患者在上述不同时间的认知功能情况及认知功能障碍(POCD)发生率,并观察患者术后不良反应的发生。结果(1)两组患者在术毕、术后24 h,3、7 d时间点IL-6和CRP的水平较术前均明显升高,且B组患者IL-6和CRP水平在术毕、术后24 h和术后3 d时明显高于A组,均差异有统计学意义(P<0.05);(3)两组患者在术毕、术后24 h及术后3 d时间点两组患者NSE和HMGB1水平较术前均升高,且B组NSE和HMGB1水平较A组升高明显,均差异有统计学意义(P<0.05),在术后7 d时A、B两组患者其HMGB1水平较前逐渐降低,但仍旧以高水平表达,且A组表达水平明显较B组低(P<0.05);(4)两组患者在术后24 h、术后3 d时简易智能量表(MMSE)评分较术前均降低,且B组较A组降低明显,均差异有统计学意义(P<0.05)。结论 右美托咪定在全麻下行妇科手术治疗老年患者的术后认知功能具有一定的保护作用,对POCD的发生具有一定的预防作用,且使用术后无明显严重不良反应,具有一定的安全性,可作为对临床上全麻手术患者广泛推行的一种麻醉辅助药物。
英文摘要:
      Objective To investigate the influence of maintenance dose DEX on postoperative cognitive function of senile patient with general anesthesia after gynecological operation. Methods Ninety-six senile patients with general anesthesia in Department of Anesthesiology,the First Affiliated Hospital of Henan University from January 2014 to January 2016 were selected and assigned into group Aand group B,48 cases in each group.Patients were all given same anesthesia induction and maintenance dose.Group Awas given DEX intravenous infusion 0.8 μg·kg-1 and maintenance speed 0.5 μg·kg-1·h-1.Group Bwas given intravenous infusion intravenous infusion.The NSE,IL-6,CRP,HMGB1,cognitive function and POCD occurrence rate at 24 h before surgery,finish time,24 h,3 d,7 d after surgery and the adverse reactions between the two groups were evaluated and compared. Results (1)The levels of IL-6 and CRP in two groups at finish time,24 h,3 d,7 d after surgery were higher than those at before.The levels of IL-6 and CRP in group Bat finish time,24 h,3 d after surgery was higher than those in group A,the difference was statistically significant(P<0.05);(2)The levels of NSE and HMGB1 in two groups at finish time,24 h,3 d after surgery were higher than those at before,the levels of NSE and HMGB1 in group Bwas higher than those in group A,the differences were statistically significant(P<0.05),and at 7 days after operation,the level of HMGB1 in group Aand Bwas decreased gradually,but still expressed at a high level,and the expression level of HMGB1 in group Awas significantly lower than that of group B(P<0.05);(4)The level of MESS in two groups at 24 h,3 d after surgery was declined,it declined more obviously in group Bthan that in group A,the difference was statistically significant(P<0.05). Conclusions Dexmedetomidine combined with general anesthesia gynecological surgery in treating elderly patients with postoperative cognitive function has a protective effect,which has a certain preventive effect in the occurrence of POCD,with no serious adverse in the use of postoperative,and a certain degree of security.It can be used as anesthesia auxiliary drugs for treating general anesthesia surgery patients in clinical.
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