文章摘要

右美托咪定对老年全麻髋关节置换术患者术后认知功能及血清H-FABP、B-FABP水平的影响

作者: 1周才山, 1蔡亲峰, 1吴佳颖, 1甘祖仁
1 海口市中医医院麻醉科，海口 570216
通讯: 周才山 Email: zhoucaishan711@163.com
DOI: 10.3978/j.issn.2095-6959.2022.12.021

摘要

目的：探讨右美托咪定对全麻老年患者髋关节置换术后认知功能及血清心型脂肪酸结合蛋白(heart-type fatty acid-binding protein，H-FABP)、脑型脂肪酸结合蛋白(brain fatty acid binding protein，B-FABP)水平的影响。方法：选取2019年7月至2021年7月在海口市中医医院行全麻髋关节置换术患者120例，随机分为对照组(n=60)与观察组(n=60)。观察组麻醉诱导前予以0.3 μg/kg右美托咪定泵注10 min，之后调整为0.5 μg/(kg·h)维持静脉泵注，对照组予以等量生理盐水泵入。于术前及术后1、3、7 d采用简易智力状态量表(Min-Mental State Examination，MMSE)评估两组患者认知功能，记录术后认知功能障碍(postoperative cognitive dysfunction，POCD)发生率；于术前及术后1 d检测血清H-FABP、B-FABP、白细胞介素-6(interleukin-6，IL-6)及肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)水平；记录两组术后不良反应。结果：术后1、3和7 d时，观察组MMSE评分均显著高于对照组(均P<0.05)。在术后7 d内，观察组POCD发生率为13.33%，低于对照组的28.33%，差异有统计学意义(P<0.05)。术后1 d，两组血清H-FABP、B-FABP水平比术前均显著增高(均P<0.05)，而观察组血清H-FABP、B-FABP、IL-6及TNF-α水平均显著低于对照组(均P0.05)。结论：右美托咪定可控制血清H-FABP、B-FABP及炎症因子水平，有效预防全麻老年患者髋关节置换术患者POCD发生。
关键词： 右美托咪定；老年；髋关节置换术；术后认知功能障碍；脂肪酸结合蛋白

Effect of dexmedetomidine on cognitive function and serum levels of heart-type fatty acid-binding protein and brain fatty acid binding protein in elderly patients undergoing hip replacement under general anesthesia

Authors: 1ZHOU Caishan, 1CAI Qinfeng, 1WU Jiaying, 1GAN Zuren
1 Department of Anesthesiology, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, China

CorrespondingAuthor: ZHOU Caishan Email: zhoucaishan711@163.com

DOI: 10.3978/j.issn.2095-6959.2022.12.021

Abstract

Objective: To investigate the effect of dexmedetomidine on postoperative cognitive function and serum levels of heart-type fatty acid-binding protein (H-FABP) and brain fatty acid binding protein (B-FABP) in elderly patients undergoing hip replacement under general anesthesia. Methods: A total of 120 patients with hip replacement under general anesthesia in Haikou Hospital of Traditional Chinese Medicine from July 2019 to July 2021 were randomly divided into a control group (n=60) and an observation group (n=60). The observation group was given 0.3 μg/kg dexmedetomidine for 10 min before anesthesia induction, and then adjusted to 0.5 μg/(kg·h) for intravenous infusion maintenance. The control group was given the same amount of normal saline. The cognitive function of the 2 groups was evaluated by Min-Mental State Examination (MMSE) score before the operation and 1, 3, and 7 d after the operation, and the incidence of postoperative cognitive dysfunction (POCD) was recorded. The serum levels of H-FABP, B-FABP, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were detected before and 1 d after the operation. Postoperative adverse reactions of the 2 groups were recorded. Results: The MMSE scores of the observation group were significantly higher than those of the control group 1, 3, and 7 d after the operation (all P<0.05). Within 7 d after the operation, the incidence of POCD in the observation group was 13.33%, which was lower than 28.33% in the control group, and the difference was statistically significant (P<0.05). On the 1st day after the operation, the serum levels of H-FABP, B-FABP, IL-6, and TNF-α in the 2 groups were significantly lower than those before the operation (all P<0.05), while the serum levels of H-FABP and B-FABP in the observation group were significantly higher than those in the control group (both P<0.05). There was no significant difference in the incidence of postoperative nausea and vomiting, hypotension, and bradycardia between the 2 groups (all P>0.05). Conclusion: Dexmedetomidine can control the levels of serum H-FABP, B-FABP, and inflammatory factors, and effectively prevent POCD in elderly patients after hip replacement under general anesthesia.

Keywords： dexmedetomidine; elderly; hip replacement; postoperative cognitive dysfunction; fatty acid-binding protein

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