摘要
目的 观察右美托咪定（DEX）对老年髋关节置换患者认知功能及脑源性神经营养因子（brain-derived neurotrophic factor ，BDNF）和其受体酪氨酸受体激酶受体B （BDNF/TrkB）信号通路的影响。方法 选择老年髋关节置换患者60名，按随机数字表法分为3组，DEX低剂量组（A组）、DEX高剂量组（B组）和对照组（C组）。麻醉诱导前，A、B两组给予DEX负荷剂量0.5μg/kg，设定微量泵10分钟输注完成，C组微量泵输注相同容积生理盐水。麻醉诱导后：A组微量泵持续输注DEX 0.25μg/（kg·h）；B组微量泵持续输注DEX 0.5μg/（kg·h）；C组微量泵持续输注相同容积生理盐水，所有患者均泵注1h后停药。分别在DEX输注前（T1）、输注后（T2）、术后1d（T3），取患者中心静脉血检测BDNF/TrkB的含量；于T1及T2时间点采取桡动脉血和颈内静脉球部血样，进行血气分析，据此计算出Da—jvO2和CERO2。盲法记录患者术前1天、术后7天MMSE评分。结果 与C组比，A、B两组T2及T3时间点BDNF/TrkB均表达增加 （P 〈 0.05）；与A组比，B组T2及T3时间点BDNF、TrkB表达增加 （P 〈 0.05）；与C组比，A、B两组T2时间点Da-jvO2和CERO2降低 （P 〈 0.05）；与C组比，A、B两组术后7天MMSE评分增加 （P 〈 0.05）。结论 DEX 可以减少老年髋关节置换患者围术期P0CD的发生率，其机制可能与降低术中Da-jvO2和CERO2，增加BDNF/TrkB的表达有关。
0bjective To observe the influence of dexmedetomidine （DEX） on postoperative cognitive function and BDNF/TrkB signaling pathway in elderly patients undergoing total hip replacement . Methods Sixty patients over age 60 were randomly divided into three groups, DEX low dose group （A）, DEX high dose group （B） and control group （C）. Patients in A and B were loaded 0.5 μg DEX in 10 min, and C were loaded saline prior to anaesthesia. After induction of anesthesia, patients in A and B were injected 0.25μg/（kg？h） and 0.5μg/（kg？h） DEX, respectively, C were injected saline , all patients injected an hour.The vein blood were collected before DEX injection （T1）, one hour injected （T2）, and one day （T3） after operation to detect BDNF/ TrkB. The blood samples of the radial artery and the internal jugular vein were collected, and the blood gas analysis was performed to calculate the Da - jv02 and CERO2. The MMSE score were recorded at one day before operation and seven days after operation. Results The BDNF and TrkB expression in A group and B group was higher than C group at T2 and T3 （P 〈 0.05）. moreover, the BDNF and TrkB expression in B group was higher than A group at T2 and T3 （P 〈 0.05）. The Da-jv02 and CERO2 were lower at T2 in A group and B group compared to C group （P 〈 0.05） , and the MMSE in A group and B group was increased compared to C group. Conclusion The DEX could reduce the rate of POCD in elderly patients undergoing total hip replacement, and the reason might related to reduction of Da-jv02 and CERO2 and increasing expression of BDNF and TrkB
作者
程丹
庞雪
马红霞
张宏经
许会贤
颜明
CHENG Dan;PANG Xue;MA Hongxia;ZHANG Hongjing;XU Huixian;YAN Ming(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《徐州医科大学学报》
CAS
2018年第10期684-687,共4页
Journal of Xuzhou Medical University
基金
江苏省教育厅高校省级重点实验室开放课题（KJS080004）
