目的 探讨持续输注超低剂量右美托咪定对行颈动脉支架置入术(CAS)的老年患者血流动力学稳定性和术后认知功能的影响.方法 选取106例于首都医科大学附属北京世纪坛医院择期行CAS的老年患者,随机分为右美托咪定组(D组,n= 52)和对照组(C组,n=54).观察2组患者麻醉诱导前15 min(T0)、麻醉诱导后5 min(T1)、置入支架前5 min(T2)、置入支架后5 min(T3)、气管拔管后5 min(T4)的血流动力学和脑灌注变化;计算平均动脉压(MAP)、心率(HR)和脑氧饱和度(rSO2)的标准差(SD),分别记作SDMAP、SDHR和SDrSO2.应用蒙特利尔认知评估量表(MoCA)对患者进行认知功能评估,比较患者术前、术后认知功能的变化,评价2组患者术后认知功能障碍(POCD)的发生情况.结果 D组患者SDMAP、SDHR和SDrSO2均明显低于C组(P＜0.05);D组麻醉药及血管活性药使用量明显低于C组(P＜0.05);D组拔管时间明显短于C组(P＜0.05);D组术后1 d MoCA评分明显高于C组,术后30 d POCD发生率明显低于C组(P＜0.05).结论 持续输注超低剂量右美托咪定可维持血流动力学和脑灌注稳定,减少麻醉药物用量,促进术后认知功能恢复.
Effects of continuous infusion of extremely low-dose dexmedetomidine on the hemodynamic stability and postoperative neurological function of older adult patients undergoing CAS
Objective To investigate the effects of continuous infusion of extremely low-dose dexmedetomidine on the hemodynamic sta-bility and recovery of postoperative cognition of older adult patients undergoing carotid artery stenting(CAS).Methods 106 older adult patients undergoing CAS were randomly divided into the dexmedetomidine(group D,n= 52)and control groups(group C,n= 54).Hemo-dynamic and cerebral perfusion changes were recorded 15 min before anesthesia induction(T0),5 min after anesthesia induction(T1),5 min before stent placement(T2),5 min after stent placement(T3),and 5 min after tracheal extubation(T4).The standard deviations(SD)of mean arterial pressure(MAP),heart rate(HR),and regional cerebral oxygen saturation(rSO2)were calculated as SDMAP,SDHR,and SDrSO2,respectively.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate and compare changes in pre-and post-operative cognitive function and examine the incidence of postoperative cognitive dysfunction(POCD)in the two groups.Results SDMAP,SDHR,and SDrSO2 in group D were significantly lower than those in group C(P＜0.05).The applied dosages of anesthetics and vasoactive drugs were significantly lower in group D than C(P＜0.05).Extubation time in group D was significantly shorter than that in group C(P＜0.05).MoCA scores in group D were significantly higher one day after CAS than that in group C and POCD incidence was significantly lower in group D one month after CAS(P＜0.05).Conclusion Continuous infusion of low-dose dexmedetomidine has the potential to maintain hemodynamic stability and cerebral perfusion,reduce the dosage of anesthetic drugs,and improve postoperative cognitive performance in older adult patients.
万方数据
维普
