中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
Chinese Journal of Anesthesiology
2015年
6期
671-673
,共3页
杨丽华%徐玉灿%李志松%王中玉%张卫
楊麗華%徐玉燦%李誌鬆%王中玉%張衛
양려화%서옥찬%리지송%왕중옥%장위
右美托咪啶%胸廓切开术%呼吸,人工%认知障碍%手术后并发症
右美託咪啶%胸廓切開術%呼吸,人工%認知障礙%手術後併髮癥
우미탁미정%흉곽절개술%호흡,인공%인지장애%수술후병발증
Dexmedetomidine%Thoracotomy%Respiration,artificial%Cognition disorders%Postoperative complications
目的 评价右美托咪定对单肺通气患者开胸术后认知功能障碍(POCD)的影响.方法 择期开胸术患者62例,年龄45~64岁,体重指数17.5~ 25.5 kg/m2.采用随机数字表法,将患者分为右美托咪定组(Dex组)和对照组(C组),每组31例.Dex组于麻醉诱导前静脉泵注右美托咪定0.5 μg/kg,泵注10 min,随后静脉泵注0.5 μg· kg-1·h-1至手术结束前30 min;C组给予等量生理盐水.于麻醉诱导前、术后24、48和72 h时采集静脉血标本,采用ELISA法检测血清S-l00β蛋白和神经元特异性烯醇化酶(NSE)水平.术后72 h时采用简明心智评分测验量表评定POCD的发生情况.结果 与麻醉诱导前比较,2组术后各时点血清S-100β蛋白和NSE水平升高(P<0.01);与C组比较,Dex组术后各时点血清S-100β蛋白及NSE水平降低(P<0.01),术后72 h时POCD发生率明显降低(26% vs 6%,P<0.05).结论 右美托咪定可有效减轻单肺通气开胸术患者的神经损伤,明显抑制POCD发生,提示其适宜作为开胸术麻醉用药.
目的 評價右美託咪定對單肺通氣患者開胸術後認知功能障礙(POCD)的影響.方法 擇期開胸術患者62例,年齡45~64歲,體重指數17.5~ 25.5 kg/m2.採用隨機數字錶法,將患者分為右美託咪定組(Dex組)和對照組(C組),每組31例.Dex組于痳醉誘導前靜脈泵註右美託咪定0.5 μg/kg,泵註10 min,隨後靜脈泵註0.5 μg· kg-1·h-1至手術結束前30 min;C組給予等量生理鹽水.于痳醉誘導前、術後24、48和72 h時採集靜脈血標本,採用ELISA法檢測血清S-l00β蛋白和神經元特異性烯醇化酶(NSE)水平.術後72 h時採用簡明心智評分測驗量錶評定POCD的髮生情況.結果 與痳醉誘導前比較,2組術後各時點血清S-100β蛋白和NSE水平升高(P<0.01);與C組比較,Dex組術後各時點血清S-100β蛋白及NSE水平降低(P<0.01),術後72 h時POCD髮生率明顯降低(26% vs 6%,P<0.05).結論 右美託咪定可有效減輕單肺通氣開胸術患者的神經損傷,明顯抑製POCD髮生,提示其適宜作為開胸術痳醉用藥.
목적 평개우미탁미정대단폐통기환자개흉술후인지공능장애(POCD)적영향.방법 택기개흉술환자62례,년령45~64세,체중지수17.5~ 25.5 kg/m2.채용수궤수자표법,장환자분위우미탁미정조(Dex조)화대조조(C조),매조31례.Dex조우마취유도전정맥빙주우미탁미정0.5 μg/kg,빙주10 min,수후정맥빙주0.5 μg· kg-1·h-1지수술결속전30 min;C조급여등량생리염수.우마취유도전、술후24、48화72 h시채집정맥혈표본,채용ELISA법검측혈청S-l00β단백화신경원특이성희순화매(NSE)수평.술후72 h시채용간명심지평분측험량표평정POCD적발생정황.결과 여마취유도전비교,2조술후각시점혈청S-100β단백화NSE수평승고(P<0.01);여C조비교,Dex조술후각시점혈청S-100β단백급NSE수평강저(P<0.01),술후72 h시POCD발생솔명현강저(26% vs 6%,P<0.05).결론 우미탁미정가유효감경단폐통기개흉술환자적신경손상,명현억제POCD발생,제시기괄의작위개흉술마취용약.
Objective To evaluate the effect of dexmedetomidine on cognitive dysfunction after thoracic surgery in patients undergoing one-lung ventilation.Methods Sixty-two patients,aged 45-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index ranged from 17.5 to 25.5 kg/m2,scheduled for elective thoracic surgery,were randomly allocated into 2 groups (n =31 each) using a random number table:dexmedetomidine group (Dex group) and control group (C group).Dexmedetomidine 0.5 μg/kg was infused for 10 min starting from the time point before induction of anesthesia,followed by continuous infusion at a rate of 0.5 μg · kg-1 · h-1 until 30 min before the end of surgery in Dex group.The equal volume of normal saline was administered instead in group C.Before induction and at 24,48 and 72 h after surgery,venous blood samples were collected for determination of levels of S-100 beta protein and neuronspecific enolase in serum by ELISA.Cognitive function was assessed by Mini-Mental State Examination at 72 h after surgery.Results The levels of S-100 beta protein and neuron-specific enolase in serum were significantly increased after surgery than before induction in the two groups.Compared to C group,the levels of S-100 beta protein and neuron-specific enolase in serum were significantly decreased after surgery,and the incidence of postoperative cognitive dysfunction was decreased in Dex group (26% vs 6%).Conclusion Dexmedetomidine can effectively reduce the nerve damage during one-lung ventilation and significantly inhibit the development of postoperative cognitive dysfunction in patients undergoing thoracic surgery,indicating that dexmedetomidine is suitable for thoracic surgery.