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摘要：
目的 探讨脑氧饱和度监测下右美托咪定对老年胸腔镜手术患者术后谵妄发生率和血清s-100β蛋白的影响。方法 选取择期拟行电视胸腔镜手术的老年患者72例，年龄65～75岁，ASA分级I～Ⅱ级，性别不限。采用随机数字表法分为2组右美托咪定组（D组）和对照组（C组）,每组36例。D组患者麻醉诱导前给予右美托咪定负荷剂量0.5μg•kg-1，输注时间15min，然后以0.3～0.5μg•kg-1•h-1持续输注，至手术结束前30min停止；C组以相同方法静脉注射等容量0.9%氯化钠注射液。分别记录2组患者入室后5min（T0），麻醉诱导前（T1），气管插管前（T2），气管插管后即刻（T3），单肺通气前（T4），单肺通气结束时（T5），拔管前（T6），拔管后5 min（T7）平均动脉压（mean arterial pressure, MAP）、心率（heart rate, HR）、脉搏血氧饱和度（Pulse Oxygen Saturation,SpO2）、心电图(electrocardiogram, ECG)和脑氧饱和度（Cerebral regional oxygen saturation,rSO2）。于麻醉前5 min、术毕、术后24h、48h时分别采集静脉血测定s-100β蛋白浓度。于术后1、2、3d时采用谵妄评定方法中文修订版（CAM-CR）量表对两组患者进行术后谵妄的评估。结果 D组患者术后谵妄的发生率明显低于C组（P<0.05）；两组患者术毕、术后24 h血清s-100β蛋白水平含量D组明显低于C组（P<0.05）；术毕和术后48h与麻醉前5min比较两组患者血清s-100β蛋白均明显升高（P<0.05）；两组rSO2均在T5时比T0时下降明显（P<0.05）；D组患者T3时MAP明显低于C组（P<0.05），C组患者MAP T3时比T0时刻明显上升（P<0.05）；两组患者HR在T3时比T0时均有明显上升（P<0.05），SpO2差异无统计学意义（P>0.05）。结论 右美托咪定能降低老年胸腔镜手术患者术后谵妄的发生率及降低术后血清s-100β蛋白的水平，具有脑保护作用。
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Abstract: Objective To investigate the effect of dexmedetomidine on postoperative delirium in elderly patients with Video-assisted thoracoscope surgery and serum S-100β protein under cerebral oxygen saturation monitoring. Methods Seventy-two ASA I orⅡ，65-75 years old patients, scheduled for elective Video-assisted thoracoscope surgery, were randomly divided into two groups (n=36, each): Dexmedetomidine group (group D) and Control group (group C). 0.5μg•kg-1 dexmedetomidine was given intravenously during 15min in group D before anesthesia induction, then infused in 0.3~ 0.5 μg•kg-1•h-1 until 30min before the end of surgery. The same capacity of 0.9% NS was used in group C. For two groups, MAP, HR, SpO2, ECG and cerebral oxygen saturation (rSO2) were recorded respectively at the following times, 5min before operation (T0), before induction of anesthesia (T1), before intubation (T2), immediately after intubation (T3), before one lung ventilation (T4), at the end of one lung ventilation (T5), before extubation (T6). Blood samples were collected to determine the concentration of S-100β protein at 5 min before anesthesia, the end of operation, 24h and 48h after operation. The postoperative delirium of patients were evaluated using the confusion assessment method Chinese Revised Edition (CAM-CR) at 1d, 2d and 3d postoperative.
Results The incidence of postoperative delirium in group D was significantly lower than that in group C (P<0.05). The content of serum s-100β protein in group D was significantly lower than that in group C at the end of operation, and 24h after operation (P<0.05). The levels of serum s-100β protein in two groups at the end of operation, and 48h after operation were significantly higher than that at 5min before anesthesia (P<0.05). The rSO2 in two groups was significantly lower at T5 than that at T0 (P<0.05). The MAP in group D was significantly lower than that in group C at T3 (P<0.05), The MAP in group C was significantly higher at T3 than that at T0 (P<0.05); The HR in two groups was significantly higher at T3 than that at T0 (P<0.05).The SpO2 had no significant difference (P>0.05).
Conclusions Dexmedetomidine can reduce the occurrence of postoperative delirium and the level of serum s-100β protein in the elderly patients with Video-assisted thoracoscope surgery, it also possesses the protective effect of cerebral.
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