| 黄 昕,白文娅,常媛媛,滕秀飞,杨延超,万玉骁,李 阳,朱俊超.右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响*[J].,2019,19(1):63-67 |
| 右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响* |
| Effects of Dexmedetomidine on the Cerebral Oxygen Saturation and Postoperative Cognitive Function of Patients with Low Hemoglobin* |
| 投稿时间：2018-03-08 修订日期：2018-03-31 |
| DOI：10.13241/j.cnki.pmb.2019.01.013 |
| 中文关键词: 脑氧饱和度 右美托咪定 血红蛋白 术后认知功能障碍 |
| 英文关键词: Cerebral oxygen saturation Dexmedetomidine Hemoglobin concentration Postoperative cognitive dysfunction |
| 基金项目:辽宁省自然科学基金项目（20102282） |
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| 中文摘要: |
| 摘要 目的：探讨右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响。方法：选取择期在全麻行开腹妇科手术、血红蛋白8 ~ 9 g/dl的患者30例，ASA分级I ~ II级，将其随机分成两组：生理盐水组(N组)和右美托咪啶组(D组)，每组15例。两组麻醉诱导后，均行七氟醚复合瑞芬太尼静吸复合麻醉维持。D组在麻醉诱导前经15 min静脉输注右美托咪定0.5μg/kg，继之以0.3 μg·kg-1·h-1的速率输注至术毕，N组给予等容量生理盐水。分别于入室时(T0)、吸氧后3 min(T1)、手术开始即刻(T2)、手术开始后10 min(T<3/sub>)、20 min(T4)、30 min (T5)、手术结束即刻(T6)以及患者苏醒拔管后5 min(T7)记录平均动脉压（Mean Arterial Pressure，MAP)、心率（Heart Rate，HR)、血氧饱和度(Percutaneous Oxygen Saturation，SpO2)、呼吸末二氧化碳分压（End-Tidal Carbon Dioxide Partial Pressure，PETCO2)、脑氧饱和度（Regional Cerebral Saturation Of Oxygenation，rSO2）、脑电双频指数（Bispectral Index，BIS)以及腋温。并于术前1 d、术后1 d以及术后3 d，记录蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）数值以及术后认知功能障碍（Postoperative Cognitive Dysfunction,POCD）的发生率。结果：与N组比较，D组在T2~T6时的rSO2升高，HR降低(P<0.05)，两组各时点MAP、SpO2、PETCO2、BIS以及腋温比较差异无统计学意义(P>0.05)。与N组比较，D组术后1天、术后3天MoCA评分均显著升高，且术后认知功能障碍的发生率明显降低(P<0.05)。结论：右美托咪定能够提高低血红蛋白患者的脑氧饱和度，改善患者脑氧供需平衡，降低术后认知功能障碍的发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function ofpatients with low hemoglobin. Methods: Thirty female patients, with hemoglobin concentration of 8-9 g/dl, aged 50-65 yr, weighing 50 - 80 kg, of American Society of Anesthesiologists physical status I or II, scheduled for elective gynecologic operation were randomly divided into 2 groups (n = 15 each) using a random number table: normal saline group (group N) and dexmedetomidine group(group D). After anesthesia induction the two groups all underwent sevoflurane and remifentanil intravenous-inhalation combined anesthesia, patients in group D were given dexmedetomidine infused intravenously at a dose of 0.5 μg/kg over 15 min, before induction of anesthesia, followed by 0.3 μg·kg-1·h-1 infusion until the end of surgery, patients in group N were given an equivalent amount of normal saline infusion. Before induction of anesthesia(baseline，T0), at 3 min after the oxygen inhalation(T1), at immediately and 10 min, 20 min, 30 min after the start of the operation(T2-5), at the end of the operation (T6), and at 5 min after extubation(T7), the mean arterial pressure(MAP), heart rate(HR), percutaneous oxygen saturation(SPO2), end-tidal carbon dioxide partial pressure (PETCO2), cerebral oxygen saturation(rSO2), bispectral index(BIS), body temperature were recorded. At 1 day before the start of the operation, at 1 day, 3 day after the operation the score of Montreal Cognitive Assessment(MoCA), and the incidence of postoperative cognitive dysfunction (POCD) were also recorded. Results: Compared with group N, the rSO2 was significantly increased, the HR was decreased at the time point of T2~T6 in group D(P<0.05). There was no significant difference in the comparison of MAP, SpO2, PETCO2, BIS and axillary temperature between the two groups (P>0.05). Compared with group N, the score of MoCA at 1day, 3day after the operation was higher, and the incidence of POCD was lower in group D(P<0.05). Conclusion: Dexmedetomidine can improve the cerebral oxygen saturation in patients with low hemoglobin, as well as improving the cerebral oxygen balance, and reduce the incidence rate of POCD of patients with low hemoglobin. |
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