CAJ | 학술논문

目的评价不同剂量右美托咪定预防腹腔热灌注化疗老年患者术后认知功能障碍(POCD)的效果.方法择期腹腔热灌注化疗手术老年患者60例,年龄＞65岁,体重50 ～ 70 kg,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为4组(n=15):对照组(C组)和不同剂量右美托咪定组(D1组、D2组、D3组).D1组、D2组和D3组于麻醉诱导前经30 min静脉输注右美托咪定,负荷量分别为0.2、0.4和0.8 μg/kg,随后以0.5 μg·kg-1·h-1的速率静脉输注至术毕,C组给予等容量生理盐水.分别于麻醉诱导前30 min、气管插管后即刻、切皮即刻、切皮后1h、关腹后1 min和气管拔管即刻时,抽取静脉血样,采用ELISA法检测血清TNF-α和IL-6的浓度.记录术后7d内POCD的发生情况.结果与C组比较,D1组、D2组和D3组血清IL-6和TNF-α的浓度降低,POCD发生率下降(P＜0.05).结论右美托咪定预先给药可降低腹腔热灌注化疗老年患者POCD的发生,其机制与减轻炎性反应有关.
목적 평개불동제량우미탁미정예방복강열관주화료노년환자술후인지공능장애(POCD)적효과.방법 택기복강열관주화료수술노년환자60례,년령＞65세,체중50 ～ 70 kg,성별불한,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위4조(n=15):대조조(C조)화불동제량우미탁미정조(D1조、D2조、D3조).D1조、D2조화D3조우마취유도전경30 min정맥수주우미탁미정,부하량분별위0.2、0.4화0.8 μg/kg,수후이0.5 μg·kg-1·h-1적속솔정맥수주지술필,C조급여등용량생리염수.분별우마취유도전30 min、기관삽관후즉각、절피즉각、절피후1h、관복후1 min화기관발관즉각시,추취정맥혈양,채용ELISA법검측혈청TNF-α화IL-6적농도.기록술후7d내POCD적발생정황.결과 여C조비교,D1조、D2조화D3조혈청IL-6화TNF-α적농도강저,POCD발생솔하강(P＜0.05).결론 우미탁미정예선급약가강저복강열관주화료노년환자POCD적발생,기궤제여감경염성반응유관.
Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of postoperative cognitive dysfunction (POCD) in the elderly patients undergoing hyperthermic intraperitoneal chemotherapy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged over 65 yr,weighing 50-70kg,undergoing elective hyperthermic intraperitoneal chemotherapy,were equally and randomly assigned into 4 groups using a random number table:control group (group C),different doses of dexmedetomidine groups (groups D1-D3).In D1-3 groups,a loading dose of dexmedetomidine 0.2,0.4 and 0.8 μg/kg was infused over 30 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.5 μg· kg-1 · h-1 until the end of surgery,while the equal volume of normal saline was given in group C.After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Venous blood samples were collected at 30 min before induction of anesthesia (T0),immediately after intubation (T1),at 0 and 1 h after skin incision (T2,3),at 1 min after abdomen closure (T4) and immediately after onset of extubation (T5) for determination of serum concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by ELISA.The development of POCD was recorded within 7 days after surgery.Results Compared with group C,the serum concentrations of TNF-α and IL6 and incidence of POCD were significantly decreased in D1-D3 groups (P ＜ 0.05).Conclusion Dexmedetomidine pretreatment can decrease the development of POCD in elderly patients undergoing hyperthermic intraperitoneal chemotherapy and inhibition of inflammatory responses may be involved in the mechanism.