张明强 胡巍

摘要：目的：观察右美托咪定对老年全身麻醉患者术后认知功能的影响。方法：选择全身麻醉手术的老年患者80例，随机分成实验组和对照组，每组各40例，实验组给予0.4μg/kg负荷剂量右美托咪定后连续泵注0.4μg·kg-1.h-1右美托咪定，对照组给予等容量生理盐水。对比两组脑电双频指数（BIS）、镇痛药物剂量、手术麻醉及苏醒相关指标、手术前后检查智力状态，进行（MMSE）量表评分。结果：两组BIS比较无差异（P>0.05），而实验组瑞芬太尼、丙泊酚使用量显著低于对照组（P<0.05）。对照组术后1d、术后7d认知功能障碍发生率均高于实验组（P<0.05）。结论：右美托咪定可有效改善老年全身麻醉手术患者麻醉苏醒质量，对患者认知功能有一定保护作用。

关键词：右美托咪定;认知功能

[Abstract] Objective：To observe the effect of dexmedetomidine on postoperative cognitive function in elderly patients under general anesthesia. Methods：80 elderly patients undergoing general anesthesia were randomly divided into experimental group and control group，with 40 cases in each group. The experimental group was given 0.4μg/kg loading dose of dexmedetomidine and the control group was given 0.4μg·kg-1 · h-1 continuous pump of dexmedetomidine，while the control group was given constant volume of normal saline. The two groups were compared with each other in terms of BIS，dose of analgesic drugs，relevant indexes of surgical anesthesia and recovery，mental status before and after surgery，and MMSE scale score. RESULTS：There was no difference in BIS between the two groups（P > 0.05），while the amount of remifentanil and propofol in the experimental group was significantly lower than that in the control group（P < 0.05）. The incidence of cognitive dysfunction in the control group on day 1 and day 7 after surgery was higher than that in the experimental group（P < 0.05）. CONCLUSIONS：Dexmedetomidine can effectively improve the quality of anesthesia recovery in elderly patients undergoing general anesthesia operation，and has a protective effect on cognitive function.

【Key words】：Dexmedetomidine;Cognitive function

认知功能障碍（COPD）是老年患者的一种常见并发症，主要症状表现为术后焦虑、精神错乱和记忆受损等。增強麻醉的安全性，降低麻醉并发症已经成为目前临床麻醉医生关注的重点。本研究探讨右美托咪定对老年全身麻醉患者手术后认知功能的影响。

1.资料与方法

1.1临床资料

选择2014年3月至2015年12月在医院进行全身麻醉的老年手术患者80例，男45例、女35例，年龄60～79〔平均（68.42±8.39）〕岁，体重47～78〔平均（64.37±8.35）〕kg。随机将患者分为实验组和对照组，每组40例，两组临床资料差异无统计学意义（P>0.05），见表1。

1.2方法

两组均是气管内插管全身麻醉，实验组给予1.0μg/kg右美托咪定负荷剂量15min，然后按照1.0μg/kg剂量持续注入直至手术完毕，对照组给予相同剂量生理盐水。麻醉维持：术中根据患者麻醉需求适当增加5～10μg/kg芬太尼，并给予0.04～0.4μg·kg-1·min-1瑞芬太尼及1.5～2.5mg/kg丙泊酚持续注入。……