CAJ | 학술논문

目的探讨术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响.方法择期全麻下行腹部手术的老年病人,性别不限,BMI 19～ 25 kg/m2,年龄65～ 85岁,ASA分级Ⅰ或Ⅱ级.术后2d内评价谵妄的发生情况,将术后谵妄病人采用随机数字表法,随机分为谵妄组(D组,n=13)和右美托咪定组(Dex组,n=16).另选术后没有发生谵妄的病人13例作为对照组(C组).Dex组在谵妄发生后经10 min静脉输注右美托咪定负荷量1μg/kg,随后以0.2～ 0.7 μg·kg-·h-1速率输注.谵妄发生期间采用18氟-脱氧葡萄糖行正电子发射断层显像,分析双侧顶叶、颞叶和额叶葡萄糖标准摄取值,以反映葡萄糖代谢率.结果 Dex组所有病人于给予右美托咪定后30 min内控制了谵妄.术后谵妄病人脑葡萄糖代谢降低的脑区主要集中在顶叶、颞叶和额叶.D组和Dex组双侧顶叶、颞叶和额叶葡萄糖代谢率低于C组(P＜ 0.05)；Dex组双侧顶叶、颞叶、额叶葡萄糖代谢率高于D组(P＜0.05).结论术后谵妄老年病人脑葡萄糖代谢率明显降低,右美托咪定可控制老年病人术后谵妄发生.
목적 탐토술후섬망노년병인뇌포도당대사적변화급우미탁미정대기영향.방법 택기전마하행복부수술적노년병인,성별불한,BMI 19～ 25 kg/m2,년령65～ 85세,ASA분급Ⅰ혹Ⅱ급.술후2d내평개섬망적발생정황,장술후섬망병인채용수궤수자표법,수궤분위섬망조(D조,n=13)화우미탁미정조(Dex조,n=16).령선술후몰유발생섬망적병인13례작위대조조(C조).Dex조재섬망발생후경10 min정맥수주우미탁미정부하량1μg/kg,수후이0.2～ 0.7 μg·kg-·h-1속솔수주.섬망발생기간채용18불-탈양포도당행정전자발사단층현상,분석쌍측정협、섭협화액협포도당표준섭취치,이반영포도당대사솔.결과 Dex조소유병인우급여우미탁미정후30 min내공제료섬망.술후섬망병인뇌포도당대사강저적뇌구주요집중재정협、섭협화액협.D조화Dex조쌍측정협、섭협화액협포도당대사솔저우C조(P＜ 0.05)；Dex조쌍측정협、섭협、액협포도당대사솔고우D조(P＜0.05).결론 술후섬망노년병인뇌포도당대사솔명현강저,우미탁미정가공제노년병인술후섬망발생.
Objective To investigate the changes in cerebral glucose metabolism induced by postoperative delirium in the elderly patients and the effects of dexmedetomidine on it.Methods Forty-two patients of both sexes aged 65-85 yr with a body mass index of 19-25 kg/m2 undergoing abdominal surgery under general anesthesia were enrolled in this study.Delirium occurred during the first 2 days after operation in 39 out of the 42 patients (29/42).The 29 patients were randomly divided into 2 groups:group delirium without any treatment (group D,n =13) and group delirium + dexmedetomidine (group Dex,n =16).The remaining 13 patients did not develop delirium after operation and served as control group (group C).In group Dex a loading dose of dexmedetomidine 1 μg/kg was administered iv over 10 min after occurrence of delirium followed by continuous infusion at 0.2-0.7μg· kg-1 · h-1.PET scan was performed within the time period in which delirium occurred.18 Fluorine-deoxyglucose was injected for observation of imaging of glucose metabolism.The standard uptake value of glucose of bilateral parietal,temporal and frontal lobes was calculated.Results Delirium was controlled within 30 min after adminnistration of dexmedetomidine.Delirium significantly reduced cerebral glucose metabolism in the bilateral parietal,temporal and frontal lobes in group D as compared with group C (P ＜ 0.05).Dexmedetomidine significantly attenuated the delirium-induced decrease in cerebral glucose metabolic rate of the 3 lobes in group Dex as compared with group D (P ＜ 0.05).Conclusion Postoperative delirium reduces cerebral glucose metabolism and dexmedetomidine can significantly control pastoperative delirium in the elderly patients.