南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (4): 600-606.doi: 10.12122/j.issn.1673-4254.2021.04.18

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右美托咪定剂量对老年脊柱手术患者术后认知功能障碍发生率及Aβ和细胞因子水平的影响：120例随机对照试验

李 智，李 虎，姚尚龙，程明华，陈建颜   

  • 出版日期:2021-04-20 发布日期:2021-04-30

Effects of dexmedetomidine doses on postoperative cognitive dysfunction and serum β-amyloid and cytokine levels in elderly patients after spine surgery: a randomized controlled trial

  • Online:2021-04-20 Published:2021-04-30

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摘要： 目的 探讨右美托咪定（DEX）预防老年脊柱手术患者术后认知功能障碍（POCD）发生率的免疫调节机制及合理剂量。方法 选择行择期脊柱手术患者120例，随机分为4组：S组（n=30，0.2 μg·kg-1 ·h-1 DEX），M组（n=30，0.5 μg·kg-1 ·h-1 DEX），L组（n=30，0.8 μg·kg-1 ·h-1 DEX），C组（n=30，等容量生理盐水）；S组、M组、L组麻醉诱导前使用0.3 μg/kg负荷量DEX泵注10 min，C组 则使用等容量生理盐水泵注；全身麻醉诱导气管插管后对S组、M组、L组分别静脉泵注DEX 0.2、0.5、0.8μg·kg-1 ·h-1至手术结束 前40 min，记录苏醒时间和低血压、窦性心动过缓的发生，术前（D0）及术后1 d（D1）、3 d（D2）、7 d（D3）评估患者MMSE评分及检测Aβ、TNF-α、IL-1β和 IL-6 的血清浓度。结果 与DO比较，4组患者术后D1时间点的Aβ、TNF-α、IL-1β和 IL-6 血清水平明显升高（P<0.05）；M组、L组Aβ血清水平D3时间点下降至术前水平（P>0.05），而C组、S组仍较高水平；M组、L组的TNF-α、IL-1β和IL-6 的血清水平在D2时间点恢复术前水平（P>0.05），而C组、S组D3时间点才恢复。与C组比较，M组、L组的POCD发生率显著减少（P<0.05），但M组、L组两组之间没有显著差异。L组患者低血压和心动过缓的发生率最高（P<0.01），苏醒时间（Tw）也比其他3组长（P<0.05）。结论 围术期使用DEX0.3 μg/kg负荷剂量泵注10 min后，持续泵注0.5 μg·kg-1·h-1 DEX可控制Aβ和促炎性细胞因子血清水平，有效预防老年脊柱手术患者POCD发生。

关键词: DEX；术后认知功能障碍；β-淀粉样蛋白；细胞因子；老年

Abstract: Objective To explore the immunomodulatory mechanism and optimal dose of dexmedetomidine (DEX) for preventing postoperative cognitive dysfunction (POCD) in elderly patients undergoing spinal surgery. Methods A total of 120 elderly patients undergoing elective spinal surgery with general anesthesia were randomized into 4 groups to receive a loading dose of 0.3 μg/kg DEX for 10 min before anesthesia induction followed by maintenance doses of 0.2, 0.5, and 0.8 μg · kg-1 · h-1 (low-, medium-, and high-dose DEX groups, respectively) or an equal volume of normal saline (control group). DEX and saline was discontinued 40 min before the end of the surgery. Before induction (D0) and on day 1 (D1), day 3 (D2) and day 7 (D3) after the operation, the cognitive function of the patients was assessed using the MMSE scale and their serum levels of β-amyloid (Aβ), TNF-α, IL-1β and IL-6 were measured. The occurrence of adverse effects including bradycardia and hypotension and the recovery time of the patients were recorded. Results Compared with those on D0, serum levels of Aβ, IL-1β, IL-6, and TNF-α on D1 were markedly increased in all the groups (P<0.05); the levels of Aβ decreased to the baseline level on D3 in medium- and high-dose DEX groups (P>0.05) but remained high in the other two groups. On D2, TNF-α, L-1β and IL-6 recovered their baseline levels in medium- and high-dose DEX groups (P>0.05) but remained elevated in the other two groups. The incidences of POCD in medium- and high-dose DEX groups were comparable but significantly lower than that in the control group (P<0.05). The incidences of hypotension and bradycardia were the highest in high-dose DEX group (P< 0.01), which also had longer recovery time than the other 3 groups (P<0.05). Conclusion With a loading dose of 0.3 μg/kg followed by a maintenance doses of 0.5 μg · kg-1 · h-1 , DEX can effectively reduce the incidence of POCD in elderly patients undergoing spinal surgery by inhibiting the production of Aβ and pro-inflammatory cytokines.

Key words: dexmedetomidine; postoperative cognitive dysfunction; β-amyloid; cytokine; elderly