右美托咪定对腔隙性脑梗死患者术后谵妄的影响摘要:目的评价右美托咪定对腔隙性脑梗死患者术后谵妄的影响。方法择期行髋关节置换术的腔隙性脑梗死患者60例,分为2组(n=30):右美托咪定组(D组),对照组(C组)。D组于麻醉诱导后持续静脉泵注右美托咪定0.5μg·kg-1·h-1至术毕,C组泵注等容量生理盐水。于麻醉诱导前(T0)、术毕(T1)和术后24h(T2)抽取颈内静脉球部血样,采用ELISA法测定血清S100β蛋白和脑源性神经营养因子(BDNF)的浓度,并评估术后3d内谵妄的发生情况。结果与C组比较,D组T1、T2时S100β降低(P<0.05),BDNF升高(P<0.05),与T0时比较,2组T1、T2时血清S100β蛋白浓度升高(P<0.05),BDNF浓度降低(P<0.05)。D组术后谵妄发生率降低,术后谵妄发生的时间推迟(P<0.05)以及术后谵妄持续时间缩短(P<0.05)。结论右美托咪定可减轻腔隙性脑梗死患者脑损伤,预防和改善其术后谵妄的发生。关键词:右美托咪定;腔隙性脑梗死;谵妄EffectofdexmedetomidineonpostoperativedeliriuminlacunarinfarctionpatientsMaoXiaoyu1),ZhangWei2),LuWenliang1),LiShan1),DongTieli1)△1)DepartmentofAnesthesiology,theSecondAffiliatedHospitalofZhengzhouUniversity,450014;2)DepartmentofAnesthesiology,theFirstAffiliatedHospitalofZhengzhouUniversity,450052Abstract:ObjectiveToevaluatetheeffectofdexmedetomidineonpostoperativedelirium(POD)inlacunarinfarctionpatients.MethodsSixtypatientswithlacunarinfarction,scheduledforelectiveartificialhipreplacement,wererandomlydividedinto2groups(n=30):groupD,0.5μg·kg-1·h-1dexmedetomidineinjectedfromanesthesiainductiontotheendofsurgery,groupC,theequalvolumeofnormalsalinewasgiveninstead.Bloodsampleswerecollectedfromthejugularbulbbeforeanesthesiainduction(T0)andattheendofsurgery(T1),24hoursafterthesurgery(T2),S100βproteinandbrain-derivedneurotrophicfactor(BDNF)inserumweremeasuredbyenzyme-linkedimmunosorbentassay.EvaluatetheoccurrenceofPODwithin3daysafteroperation.ResultsComparedwithgroupC,S100βweredecreased(P<0.05)andBDNFwereincreased(P<0.05)atT1T2,theincidenceofPODwasdecreased(P<0.05).ComparedwithgroupT0,S100βwereincreased(P<0.05)andBDNFweredecreased(P<0.05)atT1T2.TheincidenceofPODingroupDwasdecreased,ingroupDtheonsettimeofdeliriumwasdelate(P<0.05)anddurationofdeliriumwasshorten(P<0.05).ConclusionDexmedetomidinecanreducingpatientswithlacunarinfarctionbraininjuryandpreventthedevelopmentofPOD.Keywords:Dexmedetomidine;lacunarinfarction;delirium术后谵妄(postoperativedelirium,POD)是指患者在经历手术后出现急性认知功能改变,主要表现为注意力、思维、感受、记忆、精神运动及睡眠周期障碍的短暂性器质性脑综合征。腔隙性脑梗死多发于中老年人,其特点为分布于脑深部灰质、脑白质或脑干的直径<2cm的小梗死[1],占所有缺血性脑梗死的25%,已成为老年手术患者中常见的并存疾病。有研究显示腔隙性脑梗死可使患者术后谵妄发生的风险增加[2、3]。右美托咪定是一种高选择性α2受体激动剂,现已广泛用于临床麻醉中,有一定的神经保护作用[4]。目前对右美托咪定是否可以改善腔隙性脑梗死患者术后谵妄尚未有研究,本研究旨在评价右美托咪定对腔隙性脑梗死患者术后谵妄的影响,为临床用药提供依据。1资料与方法1.1一般资料选取择期行髋关节置换术的腔隙性脑梗死患者60例,年龄60~80岁,ASA分级Ⅱ或Ⅲ级,体重指数18~25kg/m2,无肝、肾功能异常,长期应用镇静药物史,无颅脑外伤及酗酒史,可正常交流,术前经MMSE检测无认知功能障碍。采用随机数字表法分为2组(n=30):右美托咪定组(D组),对照组(C组)。1.2麻醉方法所有患者均术前6h禁食2h禁饮,入室后开放静脉通路,局麻下行桡动脉穿刺置管监测直接动脉压,监测SpO2、ECG和BIS值。超声引导下行颈内静脉穿刺置管并输注复方氯化钠10ml·kg-1·h-1。麻醉诱导:静脉注射咪达...