[1]张奕文,邢祖民,徐颖华,等.不同剂量右美托咪定对老年患者腹腔镜下结直肠癌手术术后早期认知功能障碍的影响[J].南方医科大学学报,2014,(05):743.
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不同剂量右美托咪定对老年患者腹腔镜下结直肠癌手术术后早期认知功能障碍的影响()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2014年05期
页码:
743
栏目:
出版日期:
2014-05-15

文章信息/Info

Title:
Effects of different doses of dexmedetomidine on cognitive dysfunction in elderly
patients early after laparoscopic surgery for colorectal cancer
作者:
张奕文邢祖民徐颖华徐世元
关键词:
右美托咪定老年术后认知功能障碍结直肠癌手术腹腔镜检查
Keywords:
dexmedetomidine elderly postoperative cognitive dysfunction laparoscopic colorectal cancer surgery
摘要:
目的观测不同剂量右美托咪定(Dex)对老年患者腹腔镜下结直肠癌手术术后早期认知功能障碍(POCD)的影响。方法
选择全麻下拟行腹腔镜下结直肠癌手术的老年患者80例,年龄65岁以上,男性47例,女性33例,患者ASAⅠ~Ⅲ级。采用随机
数字表法,随机分为4组(n=20):对照组(C组),低剂量组(D1组),中剂量组(D2组),高剂量组(D3组)。D1组、D2组和D3组在
麻醉诱导前均给予右美托咪定负荷剂量0.5 μg/kg,输注时间15 min,在气管插管后分别以0.2、0.5、0.8 μg·kg-1·h-1持续泵注Dex,
手术结束前40 min停止输注;对照组(C组)以相同方法静脉给予等容量0.9%氯化钠注射液。记录手术时间、术中和恢复期不良
反应发生情况、术毕到恢复自主呼吸时间(TR)、自主呼吸到睁眼时间(TO)、睁眼到拔除气管导管时间(TE)。4组患者进行手术前
1 d、手术后1 d与手术后3 d行简易智力状态检查法(MMSE)评分,计算出患者手术后1 d和3 d POCD的发生率。结果与C组、
D1组比较,D2组、D3组术后POCD的发生率下降,比较差异有统计学意义(P<0.05)。与C组、D1组、D2组比较,D3组术中低血
压,心动过缓发生率升高,苏醒时间延长,比较差异有统计学意义(P<0.05)。结论麻醉诱导前给予Dex0.5 μg/kg,术中以0.5、
0.8 μg·kg-1·h-1的速率输注能降低老年患者腹腔镜下结直肠癌手术术后早期POCD的发生率。以0.5 μg·kg-1·h-1的速率输注Dex
效果好,副作用少。
Abstract:
Objective To investigate the effect of different doses of dexmedetomidine (Dex) on early postoperative cognitive
dysfunction in elderly patients undergoing laparoscopic surgery for colorectal cancer. Methods Eighty ASAI-III elderly
patients (over 65 years) were randomized equally into 4 groups including a control group without dexmedetomidine and 3
dexmedetomidine groups (groups D1, D2, and D3) with loading dexmedetomidine doses of 0.2, 0.5, and 0.8 μg/kg and
maintenance doses of 0.2, 0.5, and 0.8 μg·kg-1 ·h-1, respectively. Dex was discontinued 30 min before the end of surgery. The
time of operation, adverse reactions, time from the end of surgery to spontaneous breathing recovery (TR), time from
spontaneous breathing recovery to opening eyes (TO), and time from opening eyes to extubation (TE) were recorded.
Mini-Mental State (MMSE) test was used to assess the cognitive function 1 day before and at 1 day and 3 days after the
operation. Results The incidence of postoperative cognitive dysfunction (POCD) was significantly lower in groups D2 and D3
than in the control group and group D1 (P<0.05). The incidences of hypotension and bradycardia were the highest in group D3
(P<0.05), which also had longer significantly TO and TE than the other 3 groups (P<0.05). Conclusion Dexmedetomidine with a
loading dose of 0.5 μg/kg followed by maintenance doses of 0.5 and 0.8 μg·kg-1·h-1 (preferentially 0.5 μg·kg-1·h-1) can reduce
the incidence of POCD in elderly patients undergoing laparoscopic surgery for colorectal cancer.

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更新日期/Last Update: 1900-01-01