摘要
目的 探讨脑氧饱和度监测下右美托咪定（dexmedetomidine,Dex）对老年胸腔镜手术患者术后谵妄（postoperative delirium,POD）发生率和血清S100β蛋白的影响. 方法 选取择期拟行电视胸腔镜手术的老年患者72例,年龄65～75岁,ASA分级Ⅰ、Ⅱ级,性别不限.采用随机数字表法分为两组（每组36例）：Dex组（D组）和对照组（C组）.D组患者麻醉诱导前给予Dex负荷剂量0.5 μg/kg,输注时间15 min,然后以0.3～0.5μg·kg-1·h-1持续输注,至手术结束前30 min停止;C组以相同方法静脉注射等容量0.9％氯化钠注射液.分别记录2组患者入室后5 min（To）、麻醉诱导前（T1）、气管插管前（T2）、气管插管后即刻（T3）、单肺通气前（T4）、单肺通气结束时（T5）、拔管前（T6）、拔管后5 min（T7）的MAP、HR、SpO2、ECG和脑氧饱和度（cerebral regional oxygen saturation,rSO2）.于麻醉前5 min、术毕即刻、术后24 h、术后48 h时分别采集静脉血测定S100β蛋白浓度.于术后1、2、3d时采用谵妄评定方法中文修订版（confusion assessment method-chinese reversion,CAM-CR）量表对两组患者进行POD评估. 结果 D组患者POD的发生率明显低于C组（P＜0.05）.术毕即刻、术后24 h时D组血清S100β蛋白水平明显低于C组（P＜0.05）;与麻醉前5 min时比较,两组患者术毕即刻、术后48 h时血清S100β蛋白均明显升高（P＜0.05）;两组患者T5时rSO2均比T0时下降明显（P＜0.05）.T3时D组患者MAP明显低于C组（P＜0.05）,C组患者MAP比T0时明显上升（P＜0.05）.两组患者HR比T0时均有明显上升（P＜0.05）,SpO2差异无统计学意义（P＞0.05）. 结论 Dex能降低老年胸腔镜手术患者POD的发生率,降低术后血清S100β蛋白的水平,具有脑保护作用.
Objective To investigate effects of dexmedetomidine （Dex） on postoperative delirium （POD） and serum S100β protein under cerebral oxygen saturation monitoring in elderly patients with video-assisted thoracoscope surgery.Methods Seventy-two 65-75 years old patients with ASA categories of Ⅰ and Ⅱ were scheduled for elective video-assisted thoracoscope surgery,and were randomly divided into two groups （n=36）.Dex group received intravenous infusion of 0.5 μg/kg Dex 15 min before anesthesia induction,then 0.3-0.5 μg·kg-1 ·h-1 Dex until 30 min before the end of surgery.The same volumes of vehicle was used in control group.MAP,HR,SpO2,ECG and cerebral oxygen saturation （rSO2） were recorded 5 min before operation （T0）,before induction of anesthesia（T1）,before intubation（T2）,immediately after intubation（T3）,before one lung ventilation（T4）,at the end of one lung ventilation （T5）,before extubation （T6）.Blood samples were collected to determine the concentrations of S100β protein at 5 min before anesthesia,at the end of operation,24 h and 48 h after operation.The postoperative delirium of patients were evaluated using the confusion assessment method Chinese Revised Edition （CAM-CR） at postoperative day 1,2 and 3.Results The incidence of postoperative delirium in Dex group was significantly lower than that in control group.The levels of serum S100β protein in Dex group were significantly lower than those in control group at the end of operation,and 24 h after operation.The levels of serum S100β protein in two groups at the end of operation,and 48 h after operation were significantly higher than that at 5 min before anesthesia （P〈0.05）.The rSO2 in two groups was significantly lower at T5 than that at T0 （P〈0.05）.The MAP in Dex group was significantly lower than that in control group at T3（P〈0.05）.The MAP in control group was significantly higher at T3 than that at T0（P〈0.05）.The HR in both groups was significantly higher at T3 than that at T0 （P〈0.05）.The SpO2 had no significant change （P〉0.05）.Conclusions Dex can reduce the occurrence of POD and the level of serum S100β protein in the elderly patients with video-assisted thoracoscope surgery,suggesting that it may possess neuroprotective properties.
出处
《国际麻醉学与复苏杂志》
CAS
2017年第6期487-492,共6页
International Journal of Anesthesiology and Resuscitation
关键词
脑氧饱和度
右美托咪定
电视胸腔镜手术
术后谵妄
S100Β蛋白
Cerebral oxygen saturation
Dexmedetomidine
Video-assisted thoracoscope surgery
Postoperative delirium
S100β protein
