吉林医学
吉林醫學
길림의학
JILIN MEDICAL JOURANL
2015年
2期
212-214
,共3页
右美托咪定%老年%腹腔镜手术%认知功能障碍%炎性因子
右美託咪定%老年%腹腔鏡手術%認知功能障礙%炎性因子
우미탁미정%노년%복강경수술%인지공능장애%염성인자
Dexmedetomidine%The elderly%Laparoscopic surgery%Postoperative cognitive dysfunetion%Cytokine
目的：探讨右美托咪定对老年腹腔镜手术者术后认知功能障碍（POCD）及炎性因子影响。方法：选择老年腹腔镜手术患者40例（ASAⅡ～Ⅲ，65～85岁），随机分为DXM组、对照组（C组），每组20例。DXM组麻醉前静脉推注右美托咪定0.5μg/kg，以0.5μg/（kg·h）维持至手术结束前30 min，C组应用生理盐水，于术前1天（T0）、术后24 h（T1）、48 h（T2）、72 h（T3）测血清IL-6、TNF-α浓度，进行简易智能量表评分（MMSE）及视觉模拟评分（VAS）。结果：T1～3时MMSE评分较T0降低，DXM组T1～2时高于C组，其术后72 h POCD发生率低于C组，术后24 hC组VAS评分高于DXM组（P＜0.05）；T1～2时血清IL-6、TNF-α水平高于术前，DXM组低于C组（P＜0.05）。结论：右美托咪定能缓解老年腹腔镜手术患者术后早期认知功能障碍，下调血清IL-6和TNF-α表达。
目的：探討右美託咪定對老年腹腔鏡手術者術後認知功能障礙（POCD）及炎性因子影響。方法：選擇老年腹腔鏡手術患者40例（ASAⅡ～Ⅲ，65～85歲），隨機分為DXM組、對照組（C組），每組20例。DXM組痳醉前靜脈推註右美託咪定0.5μg/kg，以0.5μg/（kg·h）維持至手術結束前30 min，C組應用生理鹽水，于術前1天（T0）、術後24 h（T1）、48 h（T2）、72 h（T3）測血清IL-6、TNF-α濃度，進行簡易智能量錶評分（MMSE）及視覺模擬評分（VAS）。結果：T1～3時MMSE評分較T0降低，DXM組T1～2時高于C組，其術後72 h POCD髮生率低于C組，術後24 hC組VAS評分高于DXM組（P＜0.05）；T1～2時血清IL-6、TNF-α水平高于術前，DXM組低于C組（P＜0.05）。結論：右美託咪定能緩解老年腹腔鏡手術患者術後早期認知功能障礙，下調血清IL-6和TNF-α錶達。
목적：탐토우미탁미정대노년복강경수술자술후인지공능장애（POCD）급염성인자영향。방법：선택노년복강경수술환자40례（ASAⅡ～Ⅲ，65～85세），수궤분위DXM조、대조조（C조），매조20례。DXM조마취전정맥추주우미탁미정0.5μg/kg，이0.5μg/（kg·h）유지지수술결속전30 min，C조응용생리염수，우술전1천（T0）、술후24 h（T1）、48 h（T2）、72 h（T3）측혈청IL-6、TNF-α농도，진행간역지능량표평분（MMSE）급시각모의평분（VAS）。결과：T1～3시MMSE평분교T0강저，DXM조T1～2시고우C조，기술후72 h POCD발생솔저우C조，술후24 hC조VAS평분고우DXM조（P＜0.05）；T1～2시혈청IL-6、TNF-α수평고우술전，DXM조저우C조（P＜0.05）。결론：우미탁미정능완해노년복강경수술환자술후조기인지공능장애，하조혈청IL-6화TNF-α표체。
Objective To study the Effects of dexmedetomidine on postoperative cognitive dysfunction and expressions of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) in aged patients undergoing laparoscopic surgery.Methods A total of 40 elderly patients(ASAⅡ~Ⅲ,65~85 years) scheduled for selective laparoscopic surgery were randomly divided into two groups:treated group(group DXM) and control group(group C),with 20 patients in each group.The patients of group DXM received intravenous dexmedetomidine 0.5μg/kg,and maintaind with 0.5μg/(kg·h) during the operation until 30 mins before the end of operation,and the control group just received the normal saline.Blood samples were collected from the patients 1 day before operation(T0) and 24 hours(T1),48 hours(T2),72 hours(T3) after the surgery for the determination of serum IL-6,TNF-α concentration.Analgesic efficacy was assessed after surgery based on visual analog scales(VAS).The cognitive function of the patients was assessed by mini-mental state examination(MMSE) at the time points above.Results At the time points of T1~3,the MMSE scores in the two groups were all lower than the baseline,however,the MMSE scores in group DXM were higher than the control group at T1 and T2 time points;At 72 hours after surgery,the incidence of POCD in group DXM was significantly lower than that in group C.The VAS of group DXM at 24 hours after surgery was significantly lower than that of group C(P<0.05).The serum IL-6 and TNF-α concertrations of the patients in the two groups were significantly higher than the baseline at the time points of T1~2,and which were significantly lower in group DXM than the control group (P<0.05).Conclusion Dexmedetomidine can obviously alleviate the occurance of the early POCD in the aged patients with laparoscopic surgery,and the mechanisms may be related to down-regulation of IL-6 and TNF-α expression.
