右美托咪定对腹腔镜手术患者血清炎症因子及术后认知功能的影响

饶青 丛海涛

[摘要] 目的 探討右美托咪定对腹腔镜手术患者血清炎症因子及术后认知功能的影响。 方法 选取2016年1月到2019年6月在我院行腹腔镜手术患者84例，随机分为观察组和对照组，每组各42例。观察组麻醉诱导前予静脉泵注负荷剂量右美托咪定0.5 μg/kg，并以0.1 μg/（kg·h）速度持续泵注至术前30 min;对照组予等剂量生理盐水替代。观察两组术前（T1）、手术结束时（T2）、术后24 h（T3）及术后48 h（T4）血清白介素（IL）-6和肿瘤坏死因子（TNF）-α水平的变化，并比较T1、T3和T4时认知功能的变化。 结果 两组T2、T3和T4时血清IL-6和TNF-α水平均较T1时显著上升（P<0.05或P<0.01），且对照组上升值较观察组更显著（P<0.05）;同时两组T2、T3和T4时TMT完成时间较T1明显上升，MMSE评分较T1显著下降（P<0.05或P<0.01），且对照组变化值较观察组更明显（P<0.05）。结论 右美托咪定用于腹腔镜手术患者可改善术后认知功能，减轻手术及麻醉对其认知功能的影响，其作用机制可能是抑制炎症因子IL-6和TNF-α的分泌，减轻炎症因子对神经功能的损伤。

[关键词] 腹腔镜手术;右美托咪定;炎症因子;术后认知功能

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2021）08-0111-04

Effects of dexmedetomidine on serum inflammatory factors and postoperative cognitive function in patients undergoing laparoscopic surgery

RAO Qing   CONG Haitao

Department of Anesthesiology， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Taizhou  317000， China

[Abstract] Objective To investigate the effect of dexmedetomidine on serum inflammatory factors and postoperative cognitive function in patients undergoing laparoscopic surgery. Methods Eighty-four patients who underwent laparoscopic surgery in our hospital from January 2016 to June 2019 were seleted and randomly divided into observation group and control group， with 42 patients in each group. In the observation group， the loading dose of dexmedetomidine was injected intravenously before anesthesia induction at 0.5 μg/kg， and was continuously pumped until 30 min before surgery at the rate of 0.1 μg/（kg·h）. The control group was given equal dose normal saline instead. The changes in serum levels of interleukin（IL）-6 and tumor necrosis factor（TNF）-α were observed before（T1）， at the end of operation（T2）， 24 hours after operation（T3） and 48 hours after operation（T4）， and the changes in cognitive function at T1， T3 and T4 were compared. Results The levels of serum IL-6 and TNF-α in the two groups at T2， T3 and T4 were significantly higher than those at T1（P<0.05 or P<0.01）， and the levels of IL-6 and TNF-α in the control group were significantly higher than those in the observation group（P<0.05）. At the same time， at T2， T3 and T4， the completion time of TMT was significantly increased compared with T1， and MMSE score was significantly decreased compared with T1（P<0.05 or P<0.01）， and the change value in the control group was more significant than that in the observation group（P<0.05）. Conclusion Dexmedetomidine can improve postoperative cognitive function of patients undergoing laparoscopic surgery， and reduce the influence of surgery and anesthesia on cognitive function of patients. The mechanism of action may be to reduce the damage of inflammatory factors on nerve function by inhibiting the secretion of inflammatory cytokines IL-6 and TNF-α.

[Key words] Laparoscopic surgery; Dexmedetomidine; Inflammatory factors; Postoperative cognitive function

腹腔镜手术具有手术创伤小、术中出血量少、术中恢复快和痛苦小等优点，已发展为临床上最常见的术式之一[1]。腹腔镜手术需全身麻醉，在高腹压及高CO2的刺激下易发生各种术后并发症，其中术后认知功能障碍较常见[2]。术后认知功能障碍的发病机制尚不完全清楚，其中中枢性炎症因子水平异常在其发病中起极其重要的作用[3-4]。右美托咪定作为一种新型高选择性α2肾上腺素受体激动剂，不仅具有拮抗交感活性效应，还有控制炎症反应的作用，但其对腹腔镜手术患者血清炎症因子水平的影响国内报道较少[5-6]。本研究观察了右美托咪定对腹腔镜手术患者血清炎症因子及术后认知功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2016年1月至2019年6月我院行腹腔镜手术患者84例。纳入标准[7]：①美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，年龄18～80岁者;②心脑和肝肾功能无明显异常者。……