右美托咪定对腹腔镜前列腺癌根治术老年患者局部脑氧饱和度和术后认知功能的影响

目的观察右美托咪定对腹腔镜前列腺癌根治术老年患者对局部脑氧饱和度(rSO_2)和术后认知功能的影响。方法选择择期行腹腔镜前列腺癌根治手术的老年患者60例,年龄65~80岁,ASA分级Ⅰ~Ⅲ级,随机均分为两组:右美托咪定组(D组)在全麻诱导插管后泵注右美托咪定0.5μg/kg,10min泵注完毕,然后以0.5μg·kg~(-1)·h~(-1)的速度持续泵注至手术结束前30min,对照组(C组)泵入等量的生理盐水。术中使用FORE-SIGHT_脑氧饱和度监测仪监测rSO_2。记录入室时(T_0)、诱导插管后(T_1)、气腹后60min(T_2)和苏醒后(T_3)的rSO_2、MAP、PaCO_2和PaO_2。记录丙泊酚和瑞芬太尼的使用情况、术后躁动和恶心呕吐的发生情况。于术前1d、术后1d和3d使用蒙特利尔认知功能评分量表(MoCA)进行评分,记录患者术后认知功能障碍(POCD)发生情况。结果T_2时两组rSO_2、PaCO_2明显高于T_1时(P0.05)。D组患者丙泊酚和瑞芬太尼用量明显少于C组(P0.05)。D组MoCA评分明显高于C组(P0.05);D组2例(6.7%)患者发生POCD,明显低于C组的9例(30%)(P0.05)。结论右美托咪定用于老年患者腹腔镜前列腺癌根治手术对rSO_2未见明显影响,但可以减少POCD的发生。

Effect of dexmedetomidine on regional cerebral oxygen saturation and postoperative cognitive function in elder patients undergoing laparoscopic prostatectomy

Objective To observe the effect of dexmedetomidine on regional cerebral oxygen saturation and postoperative cognitive function in elder patients undergoing laparoscopic prostatectomy.Methods Sixty patients aged 65-80,ASA Ⅰ-Ⅲ and undergoing laparoscopic prosta-tectomy were randomly divided into two groups(n =30 each):dexmedetomidine group (group D)and control group (group C).Patients in the group D were given a loading dosage of dexmedetomidine 0.5μg·kg-1 ·h-1 intravenously 10 min after the induction of general anesthesia,followed by continuous infusion 0.5 μg·kg-1 ·h-1 during the operation until 30 mins before the end of operation.Patients in the control group were given 0.9% saline solution instead of dexmedetomidine.rSO 2 ,MAP,PaCO 2 and PaO 2 were collected at baseline (T0 ),after tracheal intubation (T1 ),60 min after pneumoperito-neum was achieved (T2 )and after awakening (T3 ).The consumption of propofol and remifentanil,oc-currence of agitation and PONV after surgery were recorded.On 1 d preoperative,1 d and 3 d postop-erative,the Montreal Cognitive Assessment (MoCA)was performed.The development of postopera-tive cognitive dysfunction was recorded.Results rSO2 and PaCO2 of both groups at T2 were significantly higher than those at T1 (P <0.05).In group D,the consumption of propofol and remifentanil were signifi-cantly less than that of group C (P <0.05).Compared with group C,MoCA scores in group D at 1 d after operation were increased and the incidence of postoperative cognitive dysfunction was decreased(P <0.05). Conclusion Dexmedetomidine does not significantly affect rSO 2 in elder patients undergoing laparo-scopic prostatectomy but can reduce the incidence of early POCD.