Effects of dexmedetomidine on postoperative cognitive dysfunction and inflammatory response in aged patients with general anesthesia

Weng Yanchu; Lin Mei; Su Huibin; Zhao Yuxian; Pan Jianhua; Sun Yi

doi:10.3760/cma.j.issn.1673-4378.2017.02.005

点赞 0
分享 0
收藏 0
纠错

• 论著 •

右美托咪定对老年患者全身麻醉术后认知功能障碍及炎症反应的影响

国际麻醉学与复苏杂志, 2017,38(02) : 114-117. DOI: 10.3760/cma.j.issn.1673-4378.2017.02.005

摘要

目的

观察右美托咪定（dexmedetomidine，Dex）对全身麻醉术后炎症反应及术后认知功能障碍（postoperative cognitive dysfunction，POCD）的影响。

方法

选择行择期腹部手术全身麻醉患者60例，年龄60~75岁，采用随机数字表法分为Dex组（D组）和对照组（C组），每组30例，两组患者均采用咪达唑仑0.03~0.05 mg/kg、芬太尼2~3 μg/kg、丙泊酚0.5~1.5 mg/kg、顺式阿曲库铵0.15 mg/kg静脉注射进行麻醉诱导。D组在诱导前10 min内静脉泵入1 μg/kg Dex，随后以0.2~0.7 μg·kg^-1·h^-1维持泵注，根据患者HR、BP等变化及时调整输注速率；C组则与D组相同时间和途径注入相同容积的生理盐水。分别于麻醉后手术前（T₁）、手术结束后即刻（T₂）、手术结束后24 h（T₃）抽取静脉血测定血浆IL-6含量及外周血中性粒细胞NF-κB表达水平。术前1 d或2 d及术后第1、3、7天用简易智能量表（mini-mental state examination，MMSE）测定认知功能，使用简易精神测定表（abbreviated mental test，AMT）评定术后谵妄情况。

结果

13例患者出现POCD（21.67%），其中D组3例，C组10例，两组间差异有统计学意义（P<0.05）。两组T₂、T₃时点外周血中性粒细胞NF-κB表达均较T₁时增加（P<0.05），但D组表达水平低于C组（P<0.05）。两组T₂时点血浆IL-6水平均较T₁时点明显升高（P<0.01），且C组显著高于D组（P<0.01）；两组T₃时点血浆IL-6水平较T₂时点明显下降，但仍高于T₁时点（P<0.05），T₃时点两组间差异无统计学意义（P>0.05）。D组外周血中性粒细胞NF-κB表达水平与血浆IL-6有良好的相关性（r=0.65，P<0.01）。

结论

POCD的发生可能与氧化应激反应有关，抑制NF-κB的激活可减少术后炎症反应及POCD的发生。

引用本文: 翁嫣初, 林梅, 苏惠斌, 等. 右美托咪定对老年患者全身麻醉术后认知功能障碍及炎症反应的影响 [J] . 国际麻醉学与复苏杂志,2017,38 (02): 114-117. DOI: 10.3760/cma.j.issn.1673-4378.2017.02.005

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

扫描看全文

正文

作者信息

基金 0 关键词 0

English Abstract

阅读 0 评论 0

相关资源

引用 | 论文 | 视频

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

术后认知功能障碍（postoperative cognitive dysfunction，POCD）主要表现为手术后患者出现的记忆、学习、语言、视觉空间能力、注意力、运动功能、执行力等神经心理学领域功能的改变，也包括焦虑或抑郁；POCD可大致分为急性、中间型和长期型三类，急性是指发生在术后1周，中间型是指发生在术后3个月，长期型是指术后1~2年甚至更长时间有记忆认知功能下降^[1]。氧化应激下激活的NF-κB是众多炎症介质和抗炎介质释放的共同通路，在机体炎症反应中处于枢纽位置并起着关键的作用^[2,3]。右美托咪定（dexmedetomidine，Dex）是一种新型的选择性α₂肾上腺素能受体激动剂，可有效减轻应激反应，抑制NF-κB表达^[4,5,6]。本研究拟通过在全身麻醉手术中应用Dex抑制NF-κB表达，观察NF-κB表达水平与手术炎症反应及POCD的关系。

贡献者信息

翁嫣初

215001，苏州市立医院东区麻醉科

林梅

215001，苏州高新区人民医院麻醉科

苏惠斌

215001，苏州市立医院东区麻醉科

赵玉仙

215001，苏州市立医院东区麻醉科

潘建华

215001，苏州市立医院东区麻醉科

孙怡

215001，苏州市立医院东区麻醉科

通信作者

林梅

215001，苏州高新区人民医院麻醉科

Email：linmei1919@163.com

关键词

核因子-κB; 氧化应激; 右美托咪定; 术后认知功能障碍;

历史

出版日期：2017-02-15

Original Article

Effects of dexmedetomidine on postoperative cognitive dysfunction and inflammatory response in aged patients with general anesthesia

Weng Yanchu, Lin Mei, Su Huibin, Zhao Yuxian, Pan Jianhua, Sun Yi

Published 2017-02-15

Cite as Int J Anesth Resus, 2017,38(02): 114-117. DOI: 10.3760/cma.j.issn.1673-4378.2017.02.005

Abstract

Objective

To investigate the effect of dexmedetomidine(Dex) on inflammatory response and postoperative cognitive dysfunction(POCD) after general anesthesia.

Methods

Sixty patients with ASAⅠ-Ⅱ and aged 60-75 y, undergoing the selective abdomen surgery with general anesthesia, were randomly assigned into 2 groups(n=30): Dex group(group D) and control group(group C). All patients in Both groups received 0.03-0.05 mg/kg of midazolam, 2-3 μg/kg of fentanyl, 0.5-1.5 mg/kg of propofol and 0.15 mg/kg of cisatracurium during anesthesia induction. The patients in group D were intravenously given Dex(1 μg/kg) for 10 min before induction, followed by 0.2-0.7 μg·kg^-1·h^-1 maintenance, while patients in group C were administrated the same volume of 0.9% NS and the infusion rate could be adjusted according to patients'vital signs. Blood samples were collected from the central venous to determine the plasma IL-6 level and activation of NF-κB in neutrophils before induction of anesthesia(T₁), at the end of operation(T₂), 24 h after operation(T₃). Neurocongnitive outcome was evaluated by mini-mental state examination(MMSE) and abbreviated mental test(AMT) at 1, 2 d before operation and at 1, 3, 7 d after operation.

Results

13 of 60 patients(21.67%) performed with POCD, including 3 patients in group D and 10 patients in group C(P<0.05). Compared with T₁, the activation of NF-κB in neutrophils in both groups increased significantly at T₂ and T₃(P<0.05), and was lower in group D than it in group C(P<0.05). The level of IL-6 at T₂ was significantly higher than that at T₁ and T₃ in both groups (P<0.01), and was lower in group D than it in group C at T₂(P<0.01). In group D, NF-κB activation in neutrophils was positively correlated with plasma IL-6 level(r=0.65, P<0.01).

Conclusions

The incidence of POCD was correlated with oxidative stress. Inhibition of NF-κB activation may be helpful to attenuate inflammatory cytokines in aged patients undergoing abdomen surgery with general anesthesia and reduce the incidence of POCD.

Key words:

Nuclear factor-κB; Oxidative stress; Dexmedetomidine; Postoperative cognitive dysfunction

Contributor Information

Weng Yanchu