摘要
目的观察不同剂量右美托咪定麻醉对食管癌根治术患者术后认知功能的影响,并探讨其机制。方法择期行食管癌根治术患者60例,随机分为右美托咪定1组(D1组)、右美托咪定2组(D2组)及对照组(C组)各20例,三组麻醉诱导及维持用药相同,术中切开皮肤即刻,对照组静脉输注生理盐水20 mL,D1组和D2组分别静脉输注右美托咪定0.5、1μg/kg;其后D1组和D2组分别以右美托咪定0.3、0.5μg/(kg.h)持续输注至术毕,C组输注等量生理盐水。于麻醉诱导前即刻(T1)、术毕(T2)、术后第1天(T3)、术后第7天(T4)采集患者肘静脉血样,检测超氧化物歧化酶(SOD)活性及丙二醛(MDA)、IL-6、神经元特异性烯醇化酶(NSE)水平;术前24 h及术后第1天、第3天、第7天采用简易智力状态监测表(MMSE)评估患者术前24 h、术后第1天、第3天、第7天的认知功能。结果①与T1比较,三组T2和T3时SOD活性降低,D2组T3时点SOD活性高于其他两组(P均<0.05);与T1比较,三组T2和T3时MDA水平均升高,D2组T3时点MDA水平低于其他两组(P均<0.05)。②与T1比较,三组其余时点IL-6水平均升高,D2组T2和T3时点低于其他两组(P均<0.05);与T1比较,三组T2、T3时NSE浓度升高,D2组T2、T3时点NSE浓度低于其他两组(P均<0.05)。③与术前24 h比较,术后第1天三组MMSE评分均降低,D2组术后第1、3天MMSE评分显著高于其他两组(P均<0.05);D1组、D2组和C组分别有8、4、10例发生认知功能障碍,D2组发生率显著低于D1组和C组(P<0.05)。结论 1μg/kg右美托咪定麻醉可改善食管癌根治术患者围术期认知功能,其机制可能与降低氧化应激损伤及炎症水平有关。
Objective To observe the effect of anaesthesia by different doses of dexmedetomidine on the post-operative cognitive function in patients undergoing esophageal carcinoma radical operation. Methods Sixty patients undergoing esophageal carcinoma radical operation were randomly divided into three groups （ n = 20 ）, group C （ control group）, group D1 （dexmedetomidine 0.5μg/kg）and group D2 （dexmedetomidine 1 μg/kg）. When the operation starts, dexmedetomidine 0.5 μg/kg and 1 μg/kg were infused within 10 minutes in group D1 and D2, while normal saline 20 mL in group C. Dexmedetomidine were then infused at rate of 0.3 μg/（ kg · h） and 0.5 μg/（ kg · h） until the end of operation. Venous blood samples were obtained at the time points below for the determination of superoxide dismutase（ SOD）, malonyldialdehyde（ MDA）, IL-6 and neuron specific enolase （NSE） ： the time before anaesthesia（ T1 ）, the end of operation（ T2 ）, the first day after operation（ T3 ） and the seventh day after operation（T4）. MMSE of all the patients were evaluated for the cognitive function. Results ①Compared with T1, the activity of SOD were decreased in the three groups at the time of T2 and T3, while higher in group D2 than the other two groups at the time of T3 （ all P 〈 0.05 ） ; The concentration of the MDA were increased in the three groups at the time of T2 and T3, while lower in group D2 than the other two groupsat the time of T3 （ all P 〈 0.05 ）. ②Compared with T1, the level of IL-6 was decreased in the three groups at the other time, while higher in group D2 than the other two groups at the time of T2 and 33 （ all P 〈 0.05 ） ; The concentration of NSE was decreased in the three groups at the at the time of T2 and 33, while higher in group D2 than the other two groups at the time of T2 and T3 （ all P 〈 0.05）. ③Compared with 24 hours before operation, the scores of MMSE were decreased in the three groups at the first day after operation, MMSE scores in group D2 were higher than the other two groups at 1 day and 3 days after operation（ all P 〈0.05） ; There were 8, 4 and 10 cases of POCD complicated in group D1, D2 and C, the incidence of group D2 was significantly lower than that of the group D1 and C. Conclusion Dexmedetomidine of 1 μg/kg could improve the cognitive function in patients undergoing esophageal carcinoma radical operation, the mechanism maybe lies in the effects of dexmedetomidine on the alleviation of oxidative stress injury and inflammation.
出处
《山东医药》
CAS
2013年第7期15-18,共4页
Shandong Medical Journal
基金
河南省科技厅立项课题资助项目(122300410068)
作者简介
张伟（1981-），男，硕士，主治医师，研究方向为为围术期器官保护。E-mail：myhope2005@163．com
