摘要
目的评价右美托咪定区域麻醉镇静对糖尿病老年患者术后认知功能的影响。
方法择期行糖尿病足清创术的老年患者180例，年龄65～80岁，体重45～90 kg，性别不限，ASA分级Ⅱ或Ⅲ级，术前采用简易精神状态量表（MMSE）评分〉24分，采用随机数字表法分为2组（n＝90）：右美托咪定镇静组（D组）和常规镇静组（C组）。行腰丛神经和坐骨神经阻滞，效果确切后，D组静脉输注右美托咪定0.5 μg/kg，输注时间10 min，后以0.5 μg·kg－1·h－1的速率持续输注至术毕。C组静脉注射咪达唑仑0.02～0.04 mg/kg，术中间断静脉注射1 mg。术中维持Ramsay评分2-4分。于术前30 min（T1）、手术开始后1 h（T2）、术毕即刻（T3）、术后6 h（T4）、术后24 h（T5）时分别取静脉血标本，采用快速血糖仪测定血糖，采用放免法检测血浆皮质醇（Cor）浓度，于术前1 d、术后1、3 d测定MMSE评分，记录术后短期认知功能障碍的发生情况。
结果与T1时比较，C组T2-5时血糖、T3，4时血浆Cor浓度升高，D组T3，4时血浆Cor浓度升高（P〈0.05），T2-5时血糖差异无统计学意义（P〉0.05）。与C组比较，D组T3-5时血糖、T3，4时血浆Cor浓度降低，术后1、3 d MMSE评分升高，术后短期认知功能障碍发生率降低（P〈0.05）。
结论右美托咪定区域麻醉镇静可改善糖尿病老年患者术后认知功能。
Objective To evaluate the effect of sedation with regional anesthesia with dexmedeto- midine on postoperative cognitive function in elderly patients with diabetes mellitus. Methods A total of 180 elderly patients of either sex with diabetes foot, aged 65-80 yr, weighing 45-90 kg, of American So- ciety of Anesthesiologists physical status ⅡorⅢ , with preoperative Mini-Mental State Examination score〉 24, undergoing elective d6bridement, were divided into 2 groups （ n = 90 each） using a random number table： sedation with dexmedetomidine group （group D） and routine sedation control group （group C）. Lumbar plexus block and sciatic nerve block were performed, after the reliable efficacy was achieved, dexmedetomidine was intravenously infused in a dose of 0.5 μg/kg for 10 rain followed by an infusion of 0.5μg·kg-1·h-1 until the end of surgery. Midazolam 0.02-0.04 mg/kg was intravenously injected and mid- azolam 1 mg was injected intermittently during operation in group C. Ramsay sedation scores were main- tained between 2 and 4. At 30 min before surgery （T1） , 1 h after the beginning of surgery （T2） , at the end of surgery （T3）, 6 h after the end of surgery （T4）, and 24h after the end of surgery （T5）, venous blood samples were collected for determination of the level of blood glucose and plasma cortisol （Cor） con- centrations. Mini-Mental State Examination scores were assessed at 1 day before surgery and 1 and 3 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded in a short time periodafter operation. Results Compared with the baseline at T1 , the level of blood glucose at T2_5 and plasma Cor concentrations at T3.were significantly increased in group C, and plasma Cor concentrations were sig- nificantly increased at T3,4 （P〈0.05） , and no significant change was found in the level of blood glucose at T2_5 in group D （P〉0.05）. Compared with group C, the level of blood glucose at T3-5 and plasma Cor con- centrations at T3.4 were significantly decreased, Mini-Mental State Examination scores were increased at 1 and 3 days after operation, and the incidence of postoperative cognitive dysfunction in a short time period after operation was decreased in group D （P〈0.05）. Conclusion Sedation with regional anesthesia with dexmedetomidine can improve postoperative cognitive function in elderly patients with diabetes mellitus.
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第11期1296-1299,共4页
Chinese Journal of Anesthesiology
关键词
右美托咪啶
老年人
糖尿病
认知
手术后并发症
Dexmedetomidine
Aged
Diabetes meIlitus
Cognition
Postoperative com-plications
