韦余琴 王红 陈群生 王公明

[摘要] 目的 右美托咪定對老年颈椎手术患者术后认知功能的影响。 方法 选取2016年12月～2017年5月山东省立医院行颈椎手术老年患者50例，采用随机数字表法分为右美托咪定组（DEX组）和对照组（C组），每组各25例。DEX组手术开始时静滴右美托咪定，C组则给予同等剂量的生理盐水。分别于术前及术后3、5、10、20、40 d对两组患者进行智力状态检查量表（MMSE）评分，评估患者的认知功能情况，比较两组患者术后认知功能障碍（POCD）的发生率，比较术中平均动脉血压（MAP）、心率、手术时间、出血量以及麻醉用药情况。 结果 两组患者术中MAP、心率、手术时间、出血量比较，差异无统计学意义（P > 0.05）；术中DEX组瑞芬太尼、芬太尼和丙泊酚用量低于C组，差异有统计学意义（P < 0.05）；而两组维库溴铵用量比较，差异无统计学意义（P > 0.05）；C组中术后3 d和5 d的MMSE评分均低于术前，差异有统计学意义（P < 0.05）；而DEX组中术后3和5、10、20及40 d的MMSE评分与术前比较，差异无统计学意义（P > 0.05）；DEX组术后3 d和5 d的MMSE评分均高于C组，差异有统计学意义（P < 0.05）；DEX组术后POCD的发生率为8%，C组术后POCD的发生率为24%，两组比较，差异有统计学意义（P < 0.05）。 结论 术前老年颈椎患者应用右美咪定可有效降低术后认知功能的发生率，并且在一定程度上降低了瑞芬太尼、芬太尼和丙泊酚的用量。

[关键词] 右美托咪定；老年患者；术后认知功能；MMSE评分

[中图分类号] R614.42 [文献标识码] A [文章编号] 1673-7210（2018）04（c）-0058-04

Effects of Dexmedetomidine on cognitive function in elderly patients after cervical spine surgery

WE Yuqin WANG Hong CHEN Qunsheng WANG Gongming

Department of Anesthesiology， Shandong Provincial Hospital Affiliated to Shandong University， Shandong Province， Ji′nan 250132， China

[Abstract] Objective To investigate the effects of Dexmedetomidine on cognitive function in elderly patients after cervical spine surgery. Methods From December 2016 to May 2017， 50 cases of elderly patients with receive cervical spine surgery in Shandong Provincial Hospital were selected， and divided into Dexmedetomidine group （DEX group） and control group （C group） by random number table， each group with 25 cases. The DEX group was treated with intravenous drip Dexmedetomidine at the beginning of the operation， and the C group was treated the same dose of saline. The mini-mental state examination （MMSE） was scored performed in both groups before and after surgery 3， 5， 10， 20 d and 40 d， and the cognitive function of the patient was evaluated. The postoperative cognitive dysfunction （POCD） incidence rate of the two groups was compared， and the mean arterial blood pressure （MAP）， heart rate， operation time， blood loss and the use of narcotic drugs between groups were compared during surgery. Results There was no significant difference between the two groups in the aspect of the MAP， heart rate， operation time， blood loss during surgery （P > 0.05）. The dosage of Remifentanil， Fentanyl and Propofol in the DEX group were all lower than those of C group during surgery， the differences were statistically significant （P < 0.05）， while there was no significant difference the two groups of the dosage of Vecuronium （P > 0.05）. The MMSE score of after surgery 3 d and 5 d in C group was lower than that before surgery， the difference was statistically significant （P < 0.05）， however， the MMSE scores after surgery 3， 5， 10， 20 d and 40 d in the DEX group were compared with those before surgery， the difference was not statistically significant （P > 0.05）. The MMSE score of after surgery 3 d and 5 d in the DEX group was higher than C group， the difference was statistically significant （P < 0.05）. The incidence of POCD after operation in DEX group was 8%， and the C group was 24%， the two groups were compared， the difference was statistically significant （P < 0.05）. Conclusion Dexmedetomidine can be effectively prevent the occurrence of cognitive dysfunction in elderly patients after cervical spine surgery， and it reduces the clinical dosages of Remifentanil， Fentanyl and Propofol to a certain extent.

[Key words] Dexmedetomidine； Elderly patients； Postoperative cognitive function； MMSE score

随着全球老龄化加剧，老年人患病率逐日增加，且麻醉手术后并发症亦较多见[1-2]。其中术后认知功能障碍（POCD）是最常见的并发症之一[3-5]，患者可以表现为精神系统功能紊乱，记忆力下降、自我认知功能降低等，严重者影响日常活和正常工作[6]，临床上一般采用对症治疗，其效果欠佳。为此，部分学者更加注重术前、术后用药与POCD发生率之间的关系[7]。近几年，众多学者更倾向于术前使用美托咪定对POCD的发生率的研究，并取得了初步成果。为此，本文展开了进一步的临床实验，进一步阐述右美托咪定对POCD的影响。