右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响

doi:10.3969/j.issn.1006-6233.2022.06.029

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Abstract Objective: To investigate the impacts of dexmedetomidine on cerebral oxygen saturation and postoperative cognition in elderly patients undergoing laparoscopic hepatectomy. Methods: One hundred elderly patients who were to undergo laparoscopic hepatectomy were selected, and the patients were randomly divided into experimental group and blank group using the random number table method, with 50 cases in each group. In the experimental group, dexmedetomidine 0.2ug·kg^-1·h^-1 was pumped intravenously and maintained until 30 min before the end of the operation, and in the blank group, the same amount of 0.9% saline was pumped in the same way. The MAP and HR were recorded at room entry (T₀), skin incision (T₁), start of liver incision (T₂), completion of liver incision (T₃), and end of surgery (T₄). Regional cerebral oxygen saturation (rSO₂) was monitored continuously and the mean intraoperative rSO₂ (rSO₂), the minimum intraoperative rSO₂ value (rSO_2min), and the maximum percentage decrease of rSO₂ from the basal value (rSO_2%max) were calculated. The MMSE scoring were performed at 1 d before surgery, 1, 3 and 7 d after surgery, and the occurrence of postoperative cognition disorders (POCD) and the number of days of hospitalization were recorded in the two groups, respectively. The time of awakening, time of extubation and the incidence of adverse reactions during the recovery period were recorded. Results: The MAP of the experimental group was significantly greater than that of the blank group at T₂ and T₃, and the HR was significantly lower than that of the blank group, and the difference was statistically significant (P<0.05). At the time points from T₂ to T₄, the rSO_2%max of the experimental group was significantly lower than that of the blank group, and the difference was statistically significant(P<0.05); there was no statistically significant difference in the rSO_2min and rSO₂ comparison between the 2 groups of patients (P>0.05). The incidence of POCD in the experimental group was significantly less than that in the blank group, and the difference was statistically significant (P<0.05). The hospitalization time of the experimental group was significantly shorter than that of the blank group and the difference was statistically significant (P<0.05). There was no statistic significance in revival time and the time for withdrawing the catheter between the 2 groups(P>0.05). The incidence of adverse reactions during the awakening period was significantly lower in the experimental group than in the blank group (P<0.05). Conclusion: Dexmedetomidine can maintain the stability of the patient's circulatory system, keep brain oxygen in a balanced state of supply and demand without affecting the recovery quality. It has few postoperative complications, has no effect on postoperative cognitive function, and it reduces the incidence of POCD.

Key words： Dexmedetomidine Hepatectomy Cerebral oxygen saturation Postoperative awareness Elderly patients

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.06.029 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I6/1011

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