CAJ | 학술논문

目的:探讨七氟烷复合右美托咪定对老年患者开胸术后早期认知功能的影响. 方法:选取本院2012年3月至2014年4月收治的择期行肺叶切除术的老年患者54例,随机分为实验组和对照组各27例,两组采取相同的诱导方法,此外实验组于麻醉诱导前给予0.5μg/kg 右美托咪定泵注15min,麻醉诱导后继续泵注右美托咪定0.5μg· kg-1 · h-1 ,同时持续吸入1%~3.0%七氟烷维持麻醉直至手术结束前约30min. 而对照组采取TCI泵入丙泊酚0.1mg· kg-1 · h-1. 观察两组术中及术后的生命体征指标、术中麻醉剂的用量、术后苏醒指标、术后不良反应发生情况并进行术后认知功能及相关的血清标志物的浓度的测定. 结果:术中麻醉剂用量实验组明显低于对照组的用量( P<0.05) ,实验组与对照组相比老年患者开胸术后早期认知功能障碍(POCD)的发生率明显降低(P<0.05),术后12h血清S-100β蛋白、细胞因子IL-6及 TNF-α含量实验组均明显低于对照组( P<0.05) ,术中及恢复期低血压和心动过缓发生率实验组明显高于对照组( P<0.05). 结论:七氟烷复合右美托咪定能够显著降低老年患者开胸术后POCD的发生,但该组合可能具有降低血压及致心动过缓的副作用,使用时需谨慎.
목적:탐토칠불완복합우미탁미정대노년환자개흉술후조기인지공능적영향. 방법:선취본원2012년3월지2014년4월수치적택기행폐협절제술적노년환자54례,수궤분위실험조화대조조각27례,량조채취상동적유도방법,차외실험조우마취유도전급여0.5μg/kg 우미탁미정빙주15min,마취유도후계속빙주우미탁미정0.5μg· kg-1 · h-1 ,동시지속흡입1%~3.0%칠불완유지마취직지수술결속전약30min. 이대조조채취TCI빙입병박분0.1mg· kg-1 · h-1. 관찰량조술중급술후적생명체정지표、술중마취제적용량、술후소성지표、술후불량반응발생정황병진행술후인지공능급상관적혈청표지물적농도적측정. 결과:술중마취제용량실험조명현저우대조조적용량( P<0.05) ,실험조여대조조상비노년환자개흉술후조기인지공능장애(POCD)적발생솔명현강저(P<0.05),술후12h혈청S-100β단백、세포인자IL-6급 TNF-α함량실험조균명현저우대조조( P<0.05) ,술중급회복기저혈압화심동과완발생솔실험조명현고우대조조( P<0.05). 결론:칠불완복합우미탁미정능구현저강저노년환자개흉술후POCD적발생,단해조합가능구유강저혈압급치심동과완적부작용,사용시수근신.
Objective:To explore the effect of sevoflurane combined with dexmedetomidine on postoper-ative cognitive function in elder patients after thoracotomy.Method:54 elder patients undergoing pulmonary lobectomy in our hospital from March 2012 to April 2014 were selected and randomly divided into experimen-tal group (n=27) and control group (n=27).Same induction methods were used in both groups.Experi-mental group received 15 minutes pump injection of 0.5μg/kg dexmedetomidine before anesthesia induction. After anesthesia induction, the experimental group was given pump injection of dexmedetomidine at rate of 0. 5μg· kg-1 · h-1 , and inhalation of 1%~3.0%sevoflurane was given at the same time to sustain anesthesia until 30 min before the surgery ended.The control group received Target Controlled Infusion ( TCI) of propo-fol at 0.1mg· kg-1 · h-1 .Intraoperative and postoperative vital sign indicators, intraoperative anesthetics us-age, postoperative revival indicators, postoperative occurrence of side effects of the two groups were ob-served, and the postoperative cognitive function and related serum biomarker concentration were also detec-ted.Result:The intraoperative anesthetics usage, occurrence of postoperative cognitive dysfunction (POCD) and serum level of S-100βprotein, cytokine IL-6 and TNF-α12 hours after the surgery of experimental group were obviously lower than those of control group ( all P<0.05) .Compared with control group, the oc-currence of hypotension and bradycardia in surgery and recovery phase of experimental group was clearly higher ( P<0.05) .Conclusion:Combination of sevoflurane and dexmedetomidine could significantly reduce the occurrence of POCD in elder patients after thoracotomy.However, the combination might have the side effect of leading to hypotension and bradycardia, and attention should be paid during usage.