«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年01期

页码:

66-68

栏目:

临床医学

出版日期:

2016-01-20

文章信息/Info

Title:

Effect of dexmedetomidine on cerebral oxygen saturation and cognitive function in elder patients during laparoscopic surgery

文章编号:

1006-8147（2016）01-0066-03

作者:

孟昀¹; 张华² ; 于泳浩¹

（1.天津医科大学总医院麻醉科，天津 300052；2.天津市天津医院麻醉科，天津 300211）

Author(s):

MENG Yun¹;  ZHANG Hua²;  YU Yong-hao¹

?

(1.Department of Anesthesiology, General Hospital, Tianjin Medical University Tianjin 300052, China 2. Department of Anesthesiology, Tianjin Hospital, Tianjin 300211,China)

关键词:

右美托咪定' target="_blank" rel="external">">右美托咪定; 老年人; 脑氧饱和度; 术后认知功能障碍

Keywords:

dexmedetomidine' target="_blank" rel="external">">dexmedetomidine;  elderly;  cerebral oxygen saturation; postoperative cognitive dysfunction

分类号:

R614

DOI:

-

文献标志码:

A

摘要:

目的：探讨右美托咪定对老年患者行腹腔镜手术脑氧饱和度（S_ctO₂）的变化及术后认知功能的影响。方法：选择妇科及直肠腹腔镜手术年龄≥60岁患者40例，ASA分级Ⅰ～Ⅱ级，体质量指数18～25 kg/m²，随机分为两组（n=20）：右美托咪定组（D组）和对照组（C组）。麻醉方法为气管插管全身麻醉，D组10 min泵注右美托咪定0.5 μg/kg，并按0.3 μg·kg^-1·h^-1持续泵注；C组给予等量生理盐水。应用FORE-SIGHT近红外光仪监测S_ctO₂，收集入室时(T0)、面罩吸氧后(T1)、气腹前(T2)和气腹30 min(T3)的S_ctO₂、动脉氧分压（PaO₂)、动脉二氧化碳分压(PaCO₂）、平均动脉压（MAP）。术前1 d及术后24 h对患者进行简易智能精神状态检查量表（MMSE）测试评分，计算术后认知功能障碍（POCD）发生率。结果：两组患者S_ctO₂、PaCO₂及MAP在T3时较T2时增高（P<0.05）；与术前相比，C组患者术后24 h MMSE降低（P<0.05）。结论：右美托咪定对老年腹腔镜手术患者S_ctO₂没有明显影响，但是可以降低POCD的发生率。

Abstract:

Objective：To observe the effect of dexmedetomidine on cerebral oxygen saturation (SctO₂) and cognitive function in elder patients during laparoscopic surgery. Methods：40 patients aged ≥60 years old, ASAⅠ-Ⅱ patients, with body mass index 18-25 kg/m², undergoing gynecological or rectal laparoscopic surgery were randomly divided into 2 groups （n=20 each）: dexmedetomidine group (group D) and control group (group C). The anesthesia method was general anesthesia with tracheal intubation. The FORE-SIGHT near infrared instrument was used to monitor SctO₂. Collect SctO₂, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂) and mean arterial pressure (MAP) in baseline (T0), after oxygen by mask (T1), before pneumoperitoneum (T2) and 30 minutes after pneumoperitoneum (T3). The cognitive function of patients in both groups were tested with mini-mental state examination (MMSE) Test score at 1 day before surgery, 24 hours after surgery and the incidence of postoperative cognitive dysfunction (POCD) was calculated. Results：SctO₂, PaCO₂ and MAP of both groups in T3 were significantly higher than those in T2 (P<0.05). Compared with preoperative, the MMSE at 24 hours after surgery in group C was decreased (P<0.05). Conclusion：Dexmedetomidine has no significant effect on SctO₂ in elder patients during laparoscopic surgery and can reduce the incidence of early POCD.

参考文献/References:

[1]Salameh J R, Franklin M E. Acute cholecystitis and severe ischemic cardiac disease: is laparoscopy indicated[J].JSLS,2004,8(1):61
[2]Gao F, Cao Y F, Chen L S. Meta-analysis of short-term outcomes after laparoscopic resection for rectal Cancer[J].Int J Colorectal Dis,2006,21(7):652
[3]单闯，祝建刚，刘诚，等.腹腔镜胆囊切除术中二氧化碳气腹对脑血流的影响[J].中华麻醉学杂志,2000,20(7):411
[4]Zheng M H, Lu A G, Feng B, et al. A study evaluating the safety of laparoscopic radical operation for colorectal Cancer[J].J Minim Access Surg,2005,1(1):29
[5]Kalmar A F, Foubert L, Hendrickx J F, et al. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy[J].Br J Anaesth,2010,104(4):433
[6]付学强，薛朝霞.老年人术后认知功能障碍研究现状[J].中国医疗前沿,2011,6(21):20
[7]Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral Oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia[J].Anesth Analg,2005,101(3):740
[8]Tang J F, Chen P L, Tang E J, et al. Dexmedetomidine controls agitation and facilitates reliable, serial neurological examinations in a non-intubated patient with traumatic brain injury[J].Neurocrit Care,2011,15(1):175
[9]Peng M, Wang Y L, Wang C Y, et al. Dexmedetomidine attenuates lipopolysaccharide-induced proinflammatory response in primary microglia[J].J Surg Res,2013,179(1):e219
[10]Yan M, Dai H B, Ding T T, et al. Effects of dexmedetomidine on the release of glial cell line-derived neurotrophic factor from rat astrocyte cells[J].Neurochem Int,2011,58(5):549

相似文献/References:

[1]王 凊,车绪春.调节性T细胞获得及其免疫抑制作用的实验研究[J].天津医科大学学报,2015,21(05):393.
　WANG Qing,CHE Xu-chun.Study on iTreg cells obtaining method and its immunosuppression function [J].Journal of Tianjin Medical University,2015,21(01):393.
[2]陈晓鹏,胡永成,方 成,等.血红素氧化酶1在ADSCs增殖、凋亡和成骨分化的作用[J].天津医科大学学报,2015,21(05):379.
　CHEN Xiao-peng,HU Yong-cheng,FANG Cheng,et al. Effect of proliferation, apoptosis and osteogenic differentiation of ADSCs transduced with heme oxygenase-1? [J].Journal of Tianjin Medical University,2015,21(01):379.
[3]刘 磊,李彦生,俞浩楠,等.11C左旋间羟基麻黄素制备方法的优化及改进[J].天津医科大学学报,2015,21(05):441.
　LIU Lei,LI Yan-sheng,YU Hao-nan,et al.Optimization and improvement of production of (-)-[11C]meta-Hydroxyephedrine[J].Journal of Tianjin Medical University,2015,21(01):441.
[4]李 冰,冯 凭.罗格列酮干预糖尿病大鼠脂肪组织CMKLR1及Chemerin基因表达[J].天津医科大学学报,2015,21(06):484.
　LI Bing,FENG Ping.Effect of rosiglitazone on the expression of CMKLR1 and Chemerin mRNA in the adipose tissue of diabetic rat[J].Journal of Tianjin Medical University,2015,21(01):484.
[5]LI Yan-ping,CHAI Yan-fen.?连续血液滤过对严重脓毒症患者部分炎性指标及器官功能的影响 [J].天津医科大学学报,2015,21(06):491.
　LI Yan-ping,CHAI Yan-fen.?Effect of continuous hemofiltration on inflammatory mediators and organ function in severe sepsis[J].Journal of Tianjin Medical University,2015,21(01):491.
[6]李宏亮,刘 彤,许 纲,等.红细胞分布宽度与阵发性非瓣膜性心房颤动射频消融复发的关系[J].天津医科大学学报,2016,22(02):104.
　LI Hong-liang,LIU Tong,XU Gang,et al.Association between RDW and atrial fibrillation recurrence after radiorequency catheter ablation in patients with paroxysmal non-valvular atrial fibrillation[J].Journal of Tianjin Medical University,2016,22(01):104.
[7]刘超,韩雅婷,杨 冰,等.基础医学模式生物酿酒酵母接合型的鉴定—PCR法[J].天津医科大学学报,2016,22(03):256.
　LIU Chao,HAN Ya-ting,YANG Bing,et al.Identification of the mating-type of model organism S. cerevisiae in basic medical science by PCR[J].Journal of Tianjin Medical University,2016,22(01):256.
[8]李立楠,李杉杉,刘 悦,等.神经酰胺诱导LX-2细胞凋亡抑制肝纤维发生的作用[J].天津医科大学学报,2016,22(04):283.
　LI Li-nan,LI Shan-shan,LIU Yue,et al.Effects of ceramide on promoted LX-2 cell apoptosis and inhibitting hepatic fibrosis[J].Journal of Tianjin Medical University,2016,22(01):283.
[9]王 锐,高靖达,张 卫,等.索利那新联合三联药物膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征疗效分析[J].天津医科大学学报,2016,22(04):341.
[10]陈妍,邢正英,李继彬,等.HPLC法测定黄丹兰颗粒剂中苦参碱和氧化苦参碱含量[J].天津医科大学学报,2016,22(05):452.

备注/Memo

备注/Memo:

作者简介 孟昀（1981-），女，主治医师，硕士在读，研究方向：麻醉学基础及临床研究；
通信作者：于泳浩， E-mail: yuyonghao@126.com。

常用功能

更新日期/Last Update: 2016-01-26