中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (11): 1788-1792.doi: 10.3969/j.issn.2095-4344.2015.11.027

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

右旋美托咪啶对老年腰椎手术中血流动力学及认知能力的影响

徐亚丰1，宋莺春2，徐 飞3   

  1. 1河北承德丰宁县医院麻醉科，河北省承德市 068350；河北承德医学院附属医院，2麻醉科，3骨外三科，河北省承德市 067000
  • 修回日期:2015-01-07 出版日期:2015-03-12 发布日期:2015-03-12
  • 通讯作者: 宋莺春，硕士，主治医师，河北承德医学院附属医院麻醉科，河北承德市 067000
  • 作者简介:徐亚丰，女，1974年生，河北省丰宁满族自治县人，副主任医师，主要从事临床麻醉的研究。
  • 基金资助:

    2014年承德市科学技术研究与发展计划(自筹经费第一批)项目(20142057)

Dexmedetomidine effects on hemodynamic changes and cognitive ability of elderly patients undergoing lumbar surgery

Xu Ya-feng1, Song Ying-chun2, Xu Fei3   

  1. 1Department of Anesthesia, Fengning County Hospital, Chengde 068350, Hebei Province, China; 2Department of Anethesia, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China; 3Third Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
  • Revised:2015-01-07 Online:2015-03-12 Published:2015-03-12
  • Contact: Song Ying-chun, Master, Attending physician, Department of Anethesia, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
  • About author:Xu Ya-feng, Associate chief physician, Department of Anesthesia, Fengning County Hospital, Chengde 068350, Hebei Province, China
  • Supported by:

    the Science and Technology Research and Development Plan of Chengde City in 2014, No. 20142057

PDF

727

被引次数

29

摘要：

背景：目前临床常用的麻醉药对老年患者围手术期的血流动力学和认知功能均产生一定的影响，有研究报道右旋美托咪啶对肾上腺素能受体具有高亲和力，可能对血流动力学影响甚小。

目的：观察采用右美托咪定对老年腰椎手术麻醉血流动力学及认知功能的影响。
方法：选择腰椎手术的60岁以上美国麻醉医师协会(ASA)Ⅰ-Ⅱ级拟行择期腰椎手术患者90例，随机分为3组，每组患者30例。0.5 μg组、1.0 μg组患者均于麻醉诱导后按照右美托咪定1.0 μg/kg给予负荷剂量，输注15 min，然后分别按照0.5 μg、1.0 μg持续泵入，对照组给予等量生理盐水。3组患者的麻醉诱导均采用咪唑安定0.04 mg/kg+芬太尼5 μg/kg+维酷溴铵0.1 mg/kg。比较3组患者的镇静评估及遗忘程度、全麻插管期血流动力学稳定性、术后认知功能的差异。
结果与结论：用药后5，10 min的听觉诱发电位指数3组间差异有显著性意义(P < 0.05)，1.0 μg组显著低于0.5 μg组和对照组(P < 0.05)，0.5 μg组显著低于对照组(P < 0.05)。用药10 min后1.0 μg组患者改良警觉/镇静视觉评分显著低于0.5 μg组和对照组(P < 0.05)。1.0 μg组、0.5 μg组5，10，20，30，60 min时刻的收缩压均显著高于对照组，给药后各时间点舒张压均显著高于对照组(P < 0.05)。1.0 μg组的术后认知功能障碍发生率显著低于0.5 μg组和对照组(P < 0.05)。结果提示全麻镇痛中采用右美托咪定有利于患者术中血流动力学稳定，降低术后认知障碍的发生。


中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程


全文链接：

关键词: 组织构建, 组织工程, 腰椎手术, 全麻镇痛, 右美托咪定, 临床效果

Abstract:

BACKGROUND: Commonly used anesthetics have some impacts on perioperative hemodynamics and cognitive function of elderly patients. Dexmedetomidine is reported to have high affinity with adrenergic receptors, and maybe has less hemodynamic effects.

OBJECTIVE: To observe the effects of dexmedetomidine on hemodynamics and cognitive function in elderly patients undergoing anesthesia in lumbar surgery.
METHODS: Ninety patients with American Society of Anesthesiologists I-II scheduled for lumbar surgery, aged over 60 years, were selected and randomly divided into three groups, 30 cases in each group. Patients in three groups were respectively treated with 0.5, 1.0 μg of 1.0 μg/kg dexmedetomidine and the same volume of normal saline (control group) after anesthesia induction with midazolam 0.04 mg/kg+fentanyl 5 ug/kg+Victoria Cool bromide 0.1 mg/kg. Sedation assessment, forgotten degree, hemodynamic stability in anesthesia intubation, and postoperative cognitive function were compared between three groups.
RESULTS AND CONCLUSION: There were significant differences in the auditory evoked potential between the three groups at 5 and 10 minutes after administration (P < 0.05), and the auditory evoked potential was significantly lower in the 1.0 μg group than the 0.5 μg and control groups as well as significantly lower in the 0.5 μg group than the control group. At 10 minutes after administration, the scores on modified Observer’s assessment of alterness/sedation were significantly lower in the 1.0 μg group than the 0.5 μg and control groups (P < 0.05). Compared with the control group, the systolic pressure was significantly higher in the 1.0 and 0.5 μg groups at 5, 10, 20, 30, 60 minutes after administration as well as the diastolic pressure was significantly higher in the 1.0 and 0.5 μg groups at different time after administration (P < 0.05). The incidence of postoperative cognitive impairment was significantly lower in the 1.0 μg group than the
0.5 μg group (P < 0.05). Experimental findings show that under general anesthesia, dexmedetomidine is propitious to hemodynamic stability, improves the analgesic effect and reduces the incidence of postoperative cognitive impairment.


中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程


全文链接：

Key words: Lumbar Vertebrae, Anesthesia, Analgesics

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