右美托咪啶对老年患者脑氧代谢及术后认知功能的影响

Effect of Dexmedetomidine on perioperative cerebral oxygen metabolism and postoperative cognitive function in elderly patients undergoing stomach cancer surgery

摘要:

目的 观察右美托咪啶对老年胃癌患者围手术期脑氧代谢及术后认知功能的影响。方法 将患 者分为A 组、B 组，A 组诱导前给右美托咪啶并术中维持。B 组给生理盐水；在T0 ～ T4 点采血，测动脉血 氧饱和度、血氧分压、颈内静脉球部血氧饱和度、血氧分压及血红蛋白。计算CERO2、DajO2，并用简易精 神状态检查量表（MMSE）对患者评分。结果 ①两组T1 ～ T4 时间点CERO2 及DajO2 比T0 时间点均降低 （P <0.05）；A 组T2 ～ T4 时间点CERO2、DajO2 比B 组均降低（P <0.05）；② B 组术后各时间点MMSE 评 分比术前均减低（P <0.05）；A 组术后各时间点MMSE 评分比B 组均升高（P <0.05）。结论 右美托咪啶可 降低老年胃癌患者围手术期脑氧代谢及减少术后认知功能障碍的发生。

Abstract:

Objective To investigate the effect of Dexmedetomidine on perioperative cerebral oxygen metabolism and postoperative cognitive function in the elderly patients undergoing stomach cancer surgery. Methods Using the random number table method, 120 ASA I-II elderly patients undergoing stomach cancer surgery were randomly divided into Dexmedetomidine group (group A) and control group (group B), with 60 in each group. The patients in the group A were given Dexmedetomidine before induction and for intraoperative maintenance. The patients in the group B were given the equal volume of saline. Blood samples for blood gas were taken from radial artery and jugular bulb before induction of anesthesia (T0), immediately after tracheal intubation (T1), at the end of freeing the left gastric artery (T2), at the end of gastrointestinal anastomosis (T3), at the end of operation (T4). Da-jvO2 and CERO2 were calculated at the same time. Mini-mental State Examination (MMSE) score was recorded before operation and 1, 2 and 3 d after operation. Results Compared with the T0, Da-jvO2 and CERO2 were decreased in both groups at T1-T4 (P < 0.05). Compared with the group B, Da-jvO2 and CERO2 were decreased in the group A at T2-T4 (P < 0.05). Compared with preoperative score, MMSE score was decreased at all postoperative time points in the group B (P < 0.05). Compared with the group B, MMSE score was increased at all postoperative time points in the group A (P < 0.05). Conclusions Dexmedetomidine can decrease perioperative cerebral oxygen metabolism and improve postoperative cognitive function in the elderly patients undergoing stomach cancer surgery.