CAJ | 학술논문

目的探讨右美托咪啶对老年患者术后认知功能和围术期单核细胞Toll样受体2(TLR2)和TLR4表达的影响.方法择期手术治疗的腰椎间盘突出症和腰椎骨折患者45例,年龄≥65岁,体重53～72 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为3组(n=15):对照组(Ⅰ组)和不同剂量右美托咪啶组(Ⅱ组和Ⅲ组).麻醉诱导结束后静脉输注右美托咪啶负荷剂量1.0μg/kg,输注时间15 min,然后以0.5μg/·kg-1·h-1(Ⅱ组)或1.0 μg·Jg-1·h-1(Ⅲ组)的速率静脉输注至术毕,Ⅰ组给予等容量生理盐水.于麻醉诱导前(T1)、手术开始1.5 h(T2)、术毕(T3)和术后24 h(T4)时取静脉血样,检测外周血单核细胞TLR2及TLR4的表达.分别于术前1d和术后7d时采用简易精神状态量表评分和韦氏成人记忆量表及智力量表评价认知功能,记录术后认知功能障碍的发生情况.结果与Ⅰ组比较,Ⅱ组和Ⅲ组术后认知功能障碍发生率降低,T2～T4时单核细胞TLR2和TLR4表达下调(P＜0.05)；与Ⅱ组比较,Ⅲ组术后认知功能障碍发生率降低,T～T4时单核细胞TLR2和TLR4表达下调(P＜0.05).结论右美托咪啶可预防老年患者POCD的发生,其机制与抑制单核细胞TLR2和TLR4的表达有关.
목적 탐토우미탁미정대노년환자술후인지공능화위술기단핵세포Toll양수체2(TLR2)화TLR4표체적영향.방법 택기수술치료적요추간반돌출증화요추골절환자45례,년령≥65세,체중53～72 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기수궤분위3조(n=15):대조조(Ⅰ조)화불동제량우미탁미정조(Ⅱ조화Ⅲ조).마취유도결속후정맥수주우미탁미정부하제량1.0μg/kg,수주시간15 min,연후이0.5μg/·kg-1·h-1(Ⅱ조)혹1.0 μg·Jg-1·h-1(Ⅲ조)적속솔정맥수주지술필,Ⅰ조급여등용량생리염수.우마취유도전(T1)、수술개시1.5 h(T2)、술필(T3)화술후24 h(T4)시취정맥혈양,검측외주혈단핵세포TLR2급TLR4적표체.분별우술전1d화술후7d시채용간역정신상태량표평분화위씨성인기억량표급지역량표평개인지공능,기록술후인지공능장애적발생정황.결과 여Ⅰ조비교,Ⅱ조화Ⅲ조술후인지공능장애발생솔강저,T2～T4시단핵세포TLR2화TLR4표체하조(P＜0.05)；여Ⅱ조비교,Ⅲ조술후인지공능장애발생솔강저,T～T4시단핵세포TLR2화TLR4표체하조(P＜0.05).결론 우미탁미정가예방노년환자POCD적발생,기궤제여억제단핵세포TLR2화TLR4적표체유관.
Objective To investigate the effects of dexmedetomidine on postoperative cognitive function and monocytes Toll-like receptor 2 (TLR2)and TLR 4 expression in elderly patients.Methods Forty-five ASA Ⅰ or Ⅱ elderly patients aged ≥65 yr weighing 53-72 kg were randomly divided into 3 groups: control group (group Ⅰ ) and different doses of dexmedetomidine groups(groups Ⅱ and Ⅲ ).Dexmedetomidine 1.0 μg/kg was injected iv over 15 min after anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 ·h-1 (group Ⅱ ) or 1.0 μg· kg-1 ·h-1 (group Ⅲ ) untile the end of operation.Group Ⅰ received equal volume of normal saline.Blood samples were taken before anesthesia induction,at 1.5 h after the beginning of operation,at the end of operation and at 24 h after operation(T,-T5 ) for determination of monocytes TLR2 and TLR4 expression by flow cytometrybased method.Postoperative cognitive function was evaluated at 1 d before and 7 d after operation with Mini-mental state examination and Wechsler memory scale and Wechsler adult intelligence scale,and the postoperative cognitive dysfunction was recorded.Results The incidence of postoperative cognitive dysfunction and monocytes TLR2 and TLR4 expression were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ,and in group Ⅲ than in group Ⅱ (P ＜ 0.05).Conclusion Dexmedetomidine can prevent postoperative cognitive dysfunction in elderly patients,and the mechanism may be related to down-regulation of monocytes TLR2 and TLR4 expression.