国际麻醉学与复苏杂志   2015, Issue (6): 1-1
    
右美托咪定对老年患者冠状动脉旁路移植术后认知功能的影响
谭和莲, 徐丽, 史宏伟, 魏海燕, 葛亚力1()
1.苏州大学附属第一医院麻醉科
Effects of dexmedetomidine on postoperative cognitive function in elderly patients undergoing coronary artery bypass graft surgery
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摘要:

目的 观察右美托咪定对老年患者冠状动脉旁路移植术(coronary artery bypass graft, CABG)后认知功能的影响。 方法 择期行CABG的老年患者60例,年龄60岁~70岁,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,采用随机数字表法分为两组,右美托咪定组(D组)和生理盐水对照组(C组),每组30例。D 组患者于麻醉诱导前静脉注射右美托咪定 0.6 μg/kg(15 min),随后以 0.2 μg·kg-1·h-1速率输注至术毕;C组给予等容量生理盐水;其余麻醉措施两组相同。于麻醉后手术前(T1)、心肺转流(cardiopulmonary bypass, CPB)开始后 30 min(T2)、CPB结束后 30 min(T3)、术后 6(T4)、24 h(T5)测定颈内静脉球部血清肿瘤坏死因子(tumor necrosis factor, TNF)-α、白细胞介素(interlukin, IL)-6水平及S100β蛋白浓度。分别于术前 1 d及术后第1、4、7天对患者进行简易精神状态量表(mini-mental state examination, MMSE)测验。 结果 T2~T5时,D组血清TNF-α、IL-6水平及S100β蛋白浓度明显低于C组(P<0.05)。与T1比较,T2~T5两组血清TNF-α、IL-6水平及S100β蛋白浓度均明显升高(P<0.05)。D组患者MMSE评分术后第4天[(25.2±1.4) 分]、第7天[(26.6±1.3) 分]明显低于术前1 d[(29.3±0.8) 分],C组患者MMSE评分术后第4天[(23.2±1.0) 分]、第7天[(25.6±1.3) 分]也较术前1 d[(29.4±1.0) 分]明显降低(P<0.05)。术后第4、7天,术后认知功能障碍(postoperative cognitive dysfunction, POCD)的发生率D组(36.7%、30%)均明显低于C组(46.7%、36.7%)(P<0.05)。 结论 右美托咪定可降低CPB下行CABG的老年患者POCD的发生率,其机制可能与抑制炎性反应以及S100β蛋白表达有关。

关键词: 右美托咪定; 术后认知功能障碍; 冠状动脉旁路移植术; S100β 蛋白; 炎性
Abstract:

Objective To observe the effects of dexmedetomidine on postoperative cognitive function in elderly patients undergoing coronary artery bypass graft(CABG) surgery. Methods Sixty patients, aged 60 y-70 y, American Society of Anesthesiologists(ASA) class Ⅱ or Ⅲ, scheduled for CABG were randomly divided into 2 groups(n=30). Group D received Dexmedetomidine 0.6 μg/kg intravenously over 15 min before induction of anesthesia, followed by infusion at 0.2 μg·kg-1·h-1 until the end of operation, while group C received the equal volume of normal saline. Jugular bulb blood were collected at 5 min before the beginning of operation (T1), 30 min after the beginning of cardiopulmonary bypass(CPB) (T2), 30 min after the end of CPB(T3), 6 h after the end of surgery(T4), and 24 h after the end of surgery (T5) to detect the serum levels of tumor necrosis factor(TNF)?蛳α, interleukin(IL)?蛳6 and S100β protein. The cognitive function was evaluated in the light of mini?蛳mental state examination (MMSE) 1 d before surgery, 1 d after surgery, 4 d after surgery and 7 d after surgery. Results There was no significant difference in the serum level of TNF-α, IL-6 and S100β between the two groups at T1. The serum levels of TNF-α, IL-6 and S100β in group D at T2-T5 were lower than those in group C (P<0.05). The serum levels of TNF-α, IL-6 and S100β were higher at T2-T5 compared with that at T1 in these two groups (P<0.05). The serum level of S100β increased obviously at T2 compared with T1, reached a peak at T3, and then gradually declined. There was no difference of MMSE value between the two groups before operation. The MMSE values in group D and in group C at 4, 7 d after surgery were significantly lower than that before anesthesia[group D (25.2±1.4) vs (26.6±1.3) vs (29.3±0.8), group C (23.2±1.0) vs (25.6±1.3) vs (29.4±1.0)] (P<0.05). The MMSE values in group D at 4, 7 d after operation were significantly higher than that in group C(P<0.05). The incidence rates of postoperative cognitive dysfunction(POCD) in group D were significantly lower at 4,7 d after operation than that in group C(36.7% vs 46.7%, 30% vs 36.7%) (P<0.05). Conclusions Dexmedetomidine could effectively decrease the incidence of postoperative cognitive dysfunction in the elderly patients undergoing CABG, which may be related to inhibiting inflammatory cytokine responses and S100β protein expression.

Key words: Dexmedetomidine; Postoperative cognitive dysfunction; Coronary artery bypass graft; S100β protein; Inflammatory response