| 摘要: |
| ［摘要］目的 评价右美托咪啶对老年手术患者血清S-100β蛋白、NSE浓度的影响．方法 选择髋关节置换术老年患者100例，ASA分级Ⅱ或Ⅲ级，性别不限，年龄65~75岁，体重指数＜25 kg/m2．采用随机数字表法，将患者分为2组（n＝50）：生理盐水对照组（C组）和右美托咪啶组（D组）．D组麻醉诱导前经15 min静脉注射右美托咪啶0.5 μg/kg，随后以0.4 μg/（kg·h）的速率静脉输注至术毕前30 min，C组给予等容量生理盐水．5 min后静脉注射舒芬太尼0.4 μg/kg、丙泊酚1～2 mg/kg、罗库溴铵0.6 mg/kg麻醉诱导，气管插管后行机械通气．靶控吸入七氟醚呼气末靶浓度1 %~3 %、静脉输注舒芬太尼0.2 μg/（kg·h）维持麻醉，术中维持BIS值40～60．于麻醉诱导前（T0）、术毕（T1）、术后12 h（T2）时采集颈内静脉血样，采用ELISA法测定血清S-100β蛋白和NSE浓度．术毕待拔除气管导管后送术后监护病房．采用ICU谵妄评估法对患者进行谵妄评测，记录术后24 h内谵妄的发生情况．结果 与T0时比较，2组T1~2时血清S-100β蛋白、NSE浓度升高；与C组比较，D组丙泊酚和七氟醚用量减少、T1~2时血清S-100β蛋白和NSE浓度降低、术后24 h内谵妄的发生率降低（P＜0.05）．结论 右美托咪啶可降低血清S-100β蛋白、NSE的浓度，降低老年患者术后谵妄的发生，提示其有脑保护效应． |
| 关键词: ［关键词］右美托咪啶 S-100β蛋白 NSE 谵妄 手术后并发症 老年 |
| DOI： |
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| 基金项目:［基金项目］云南省应用基础研究基金资助项目（2010ZC179） |
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| Effect of Dexmedetomidine on the Serum Concentrations of S-100β Protein and NSE in Elderly Patients Undergoing Surgery |
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YANG Yun-li1,2,3
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1.（1）Dept. of Anesthesiology，Kunming General Hospital of Chengdu Military Area，Kunming Yunnan 650032;2.２）Dept. of Anesthesiology，The First People’s Hospital of Qujing， Qujing Yunnan 655000;3.３）Kunming Medical University，Kunming Yunnan 650500，China）
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| Abstract: |
| ［Abstract］Objective To investigate the effect of dexmedetomidine on the serum concentrations of S-100β protein and neurone specific enolase （NSE） in elderly patients undergoing surgery. Methods One hundred ASAⅡor Ⅲ patients， aged 65～75 yr with a body mass index of ＜25 kg/m2， scheduled for elective hip joint replacement surgery under general anesthesia， were randomly divided into 2 groups（n =50）: control group （group C） and dexmedetomidine group （group D）. Dexmedetomidine 0.5 μg/kg was infused intravenously over 15 min before anesthesia induction in group D and was maintained 0.4 μg/(kg·h) until 30 min before operation end， while the same volume of normal saline was infused in group C. Anesthesia was induced by iv injection of sufentanil 0.4 μg/kg and propofol 1～2 mg/kg until loss of consciousness. Tracheal intubation was facilitated with 0.6 mg/kg rocuronium bromide and the patients were mechanically ventilated. Anesthesia was maintained with sevoflurane by target controlled inhalation （TCI） （end-tidal concentration set at 1 %~3%） and sufentanil 0.2 μg/(kg·h) in both groups. BIS was maintained at 40～60 during operation.Venous blood samples were obtained for determination of serum concentrations of S-100β protein and NSE before anesthesia （baseline），operation end and at 12h after operation. Patients were sent to Intensive Care Unit when operation end. All the patients were assessed for the development of delirium by experience research staff using Confusion Assessment Method for Intensive Care Unit. The incidence of postoperative delirium within 24h after operation were recorded， and compared between the two groups. Results The serum concentrations of S-100β protein and NSE was significantly increased at T1~2 than at T0 in two groups. The total dose of each anesthetic （propofol， sevoflurane）， the serum concentrations of S-100β protein and NSE， and the incidence of postoperative delirium were significantly lower in group D than in group C（P＜0.05）. Conclusions Dexmedetomidine can reduce the serum concentrations of S-100β protein and NSE， and can also reduce the occurrence of postoperative delirium in elderly patients undergoing hip joint replacement surgery. Dexmedetomidine can provides cerebral protection in elderly patients undergoing surgery. |
| Key words: ［Key words］Dexmedetomidine S-100β protein NSE Delirium Postoperative complication Aged |