CAJ | 학술논문

目的：观察亚麻醉剂量氯胺酮与负荷剂量的右美托咪定对老年人腹腔镜手术患者早期术后认知功能障碍(POCD)的影响。方法选择广东省中山市人民医院2014年4~9月,年龄60~80岁行腹腔镜手术老年患者90例。数字随机表法分为三组院对照组(C组)、右美托咪定组(D组)、氯胺酮组(K组)。三组均行气管插管全身麻醉。D组在诱导前给予0.5μg/kg右美托咪定,K组诱导前给予0.5 mg/kg氯胺酮,C组给予相同容量的0.9%氯化钠注射液。三组患者行术前1 d,术后1、2、3 d的简易智力状态检查法(MMSE)评分,计算POCD的发生率。结果①与术前1 d比较,C组和D组术后1、2 d的MMSE评分明显下降,差异有统计学意义(P<0.05)；与K组比较,C组和D组术后1、2 d的MMSE评分明显下降,差异有统计学意义(P<0.05)。②与C组比较,K组术后1、2 d的POCD发生率降低,差异有高度统计学意义(P<0.01)。结论亚麻醉剂量的氯胺酮对术后认知功能具有保护作用,能降低腹腔镜老年患者早期POCD的发生率,负荷剂量的右美托咪定不能降低腹腔镜老年患者POCD的发生率。
목적：관찰아마취제량록알동여부하제량적우미탁미정대노년인복강경수술환자조기술후인지공능장애(POCD)적영향。방법선택광동성중산시인민의원2014년4~9월,년령60~80세행복강경수술노년환자90례。수자수궤표법분위삼조원대조조(C조)、우미탁미정조(D조)、록알동조(K조)。삼조균행기관삽관전신마취。D조재유도전급여0.5μg/kg우미탁미정,K조유도전급여0.5 mg/kg록알동,C조급여상동용량적0.9%록화납주사액。삼조환자행술전1 d,술후1、2、3 d적간역지력상태검사법(MMSE)평분,계산POCD적발생솔。결과①여술전1 d비교,C조화D조술후1、2 d적MMSE평분명현하강,차이유통계학의의(P<0.05)；여K조비교,C조화D조술후1、2 d적MMSE평분명현하강,차이유통계학의의(P<0.05)。②여C조비교,K조술후1、2 d적POCD발생솔강저,차이유고도통계학의의(P<0.01)。결론아마취제량적록알동대술후인지공능구유보호작용,능강저복강경노년환자조기POCD적발생솔,부하제량적우미탁미정불능강저복강경노년환자POCD적발생솔。
Objective To observe the influence of subanesthetic dose Ketamine and loading dose Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) in the elderly patients. Methods 90 patients (60-80 years) with laparoscopic surgery in People’s Hospital of Zhongshan City from April to Septmber 2014 were randomly divided into three group:Dex group (group D), Ketamine group (group K), control group (group C). All patients were received gener-al anesthesia. Before the induction of general anesthesia, the patients in group D were received 0.5μg/kg Dex. The pa-tients in group K were received 0.5 mg/kg Ketamine. The patients in group C were received the same volume saline. Mini-mental state examination (MMSE) was used to assess the cognitive function 1 d before the operation and 1, 2, 3 d after the operation. The incidences of POCD were calculated. Results ①Compared with 1 d before surgery, the MMSE score 1, 2 d after surgery in group C and group D significently decreased (P < 0.05); compared with group K, the MMSE score 1, 2 d after surgery in group C and group D also significantly decreased (P < 0.05). ②Compared with group C, the incidence of POCD 1, 2 d after surgery in group K significantly decreased (P< 0.01). Conclusion The re-sults suggest that subanesthetic dose of Ketamine can protect the cognitive function and decrease the incidence of POCD at the earerly stage in elderly patients with laparoscopic surgery. Loading dose Dex can not decrease the inci-dence of POCD in elderly patients with laparoscopic surgery.