小剂量右美托咪定静脉输注对胸腔镜下肺癌根治术老年患者血浆β-淀粉样蛋白及术后认知功能影响的研究

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小剂量右美托咪定静脉输注对胸腔镜下肺癌根治术老年患者血浆β-淀粉样蛋白及术后认知功能影响的研究

王加芳,戚忠,祝德刚,袁军,李进,冯丹

华中科技大学同济医学院附属武汉市第一医院麻醉科,华中科技大学同济医学院附属武汉市第一医院麻醉科,华中科技大学同济医学院附属武汉市第一医院麻醉科,华中科技大学同济医学院附属武汉市第一医院麻醉科,华中科技大学同济医学院附属武汉市第一医院麻醉科,华中科技大学同济医学院附属武汉市第一医院麻醉科

收稿日期:2018-11-04 修回日期:2019-02-25 出版日期:2019-04-25

Effects of Low Dose Infusion of Dexmedetomidine on β-amyloid Protein and Post Operative Cognitive Dysfunction in Elderly Patients undergoing Radical Resection of Lung Carcinoma by Video-assisted Thoracic Surgery

WANG JiaFang,QI Zhong,ZHU DeGang,YUAN Jun,LI Jin and FENG Dan.

Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan,Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan,Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan,Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan,Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan,Department of Anesthesiology,Wuhan No Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan

Received:2018-11-04 Revised:2019-02-25 Online:2019-04-25

摘要/Abstract

摘要： 目的：探讨小剂量右美托咪定(dexmedetomidine，DEX)静脉输注对胸腔镜下肺癌根治术老年患者血浆β-淀粉样蛋白和术后认知功能的影响。方法：选取2016年6月至2018年3月我院择期全麻下拟行胸腔镜下肺癌根治术老年患者60例作为研究对象，按随机数字表法分为两组，右美托咪定组（DEX组）和生理盐水组（NS组），每组患者各30例。DEX组患者支气管插管成功后经静脉持续泵注右美托咪定0.4 μg?（kg?h）-1输注至手术结束，NS组患者泵注等量的NS。两组患者分别于麻醉开始前 (T1)及手术开始后2 h(T2)、4 h(T3)、24 h(T4)、7 d(T5)采集外周静脉血标本，采用酶联免疫吸附试验(ELISA)法测定β-淀粉样蛋白含量。两组患者分别于术前1 d和术后7 d行神经心理测验评估认知功能，比较两组患者术后认知功能障碍（post operative cognitive dysfunction，POCD）的发生率。结果：两组患者组间比较，DEX组T2～T5时点血浆β-淀粉样蛋白含量较NS组均降低(P＜0.05)。两组患者组内比较，与术前T1时点比较，两组患者 T2～T5时血浆β-淀粉样蛋白含量均逐渐升高，于T4时点达到峰值，DEX组T5时点与T1时点比较差异无统计学意义(P＞0.05)，而NS组T5时点仍高于T1时点(P＜0.05)。DEX组POCD发生率为6.7%，低于NS组的26.7%（P＜0.05）。结论：右美托咪定用于全麻下老年患者胸腔镜肺癌根治术对患者的认知功能具有保护作用，可以降低POCD的发生率，其作用机制可能与右美托咪定能降低患者血浆β-淀粉样蛋白有关。

Abstract: Objective： To investigate the effect of low dose infusion of dexmedetomidine（DEX）on β-amyloid protein and post operative cognitive dysfunction(POCD)in elderly patients undergoing radical resection of lung carcinoma by video-assisted thoracic surgery. Methods： Sixty elderly patients undergoing radical resection of lung carcinoma by video-assisted thoracic surgery from June 2016 to March 2018 in our hospital were selected as subjects.According to the random number table method， the patients were randomly divided into the dexmedetomidine group(DEX group)and normal saline group(NS group)，30 cases in each group.After endobronchial intubation，patients in DEX group were infused intravenously with a continuous infusion of dexmedetomidine 0.4 μg?（kg?h）-1 until the end of surgery. The NS group was treated with the same volume of normal saline．Peripheral venous blood samples were collected at five time points： before the surgery（T1）， 2 h after the start of the surgery (T2)， 4 h after the start of the surgery (T3)， postoperative 24 h(T4) and 7 d after the operation(T5) respectively.The samples were analyzed using β-amyloid protein enzyme linked immunosorbent assay(ELISA) kit.Cognitive function was assessed at the 1st day before operation and the 7 th day after operation， using neuropsychological tests. Results： The concentration of β-amyloid protein at T2-T5 in DEX group were lower than those at the corresponding time points in NS group(P<0.05)．In both of the two groups，the concentrations of β-amyloid protein were increased from T2， and at T4 reached the peak. In NS group the concentration of β-amyloid protein at T5 was still higher than that at T1(P＜0.01)，but in DEX group there was no significant difference between the two time points (P＞0.05). The rate of POCD in DEX group(6.7%)was lower than that in NS group(26.7%) (P＜0.05). Conclusion： Dexmedetomidine has neuroprotective effect in elderly patients undergoing radical resection of lung carcinoma by video-assisted thoracic surgery， and can reduce the incidence rate of POCD， which might be related to the reduction of the blood concentration of β-amyloid protein.

王加芳,戚忠,祝德刚,袁军,李进,冯丹. 小剂量右美托咪定静脉输注对胸腔镜下肺癌根治术老年患者血浆β-淀粉样蛋白及术后认知功能影响的研究[J]. .

WANG JiaFang,QI Zhong,ZHU DeGang,YUAN Jun,LI Jin and FENG Dan.. Effects of Low Dose Infusion of Dexmedetomidine on β-amyloid Protein and Post Operative Cognitive Dysfunction in Elderly Patients undergoing Radical Resection of Lung Carcinoma by Video-assisted Thoracic Surgery[J]. .

参考文献

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2.彭志友,封小美,薛庆生,等.胸科手术术后认知功能障碍的危险因素分析[J].临床麻醉学杂志,2011,27(5):433-435．
3.苏柏勤,游志坚,洪璞, 等. 胸腹部手术对患者术后认知功能的影响及相关危险因素分析[J]. 汕头大学医学院学报,2017,30(1):26-28.
4.Su X,Meng ZT,Wu XH,et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial[J]. Lancet ,2016,388(10054):1893-1902.
5.Zhou C,Zhu Y,Liu Z, et al. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: a meta-analysis[J]. J Int Med Res,2016,44(6):1182-1190.
6.魏芳,闻庆平,王春梅.右美托咪啶对老年患者术后认知功能影响的Meta分析[J].中国医科大学学报,2015,44(9):790-795.
7.丁玲玲,张宏,米卫东,等.右美托咪啶对老年患者在机器人辅助腹腔镜手术麻醉苏醒期及术后认知功能的影响[J].中南大学学报(医学版),2015,40(2):129-134.
8.李希明,刘中凯.单肺通气术后认知功能障碍与局部脑氧饱和度和β-淀粉样蛋白的关系[J]. 临床麻醉学杂志,2013,29(1):53-56.
9.Yamanaka D,Kawano T,Nishigaki A,et al.Preventive effects of dexmedetomidine on the development of cognitive dysfunction following systemic inflammation in aged rats[J]. J Anesth,2017,31(1):25–35.
10.Wang L,Liu H,Zhang L,et al. Neuroprotection of dexmedetomidine against cerebral ischemia-reperfusion injury in rats: involved in inhibition of NF-kappaB and inflammation response[J]. Biomol Ther,2017,25(4):383-389.
11.Carr ZJ,Cios TJ,Potter KF,et al. Does Dexmedetomidine Ameliorate Postoperative Cognitive Dysfunction? A Brief Review of the Recent Literature[J]. Curr Neurol Neurosci Rep,2018,18 (10): 64.
12.Hardy J,Selkoe DJ.The amyloid hypothesis of Alzheimer’S disease:progress and problems on the road to therapeutics[J].Science,2002,297:353-356．
13.Li XM,Shao MT,Wang JJ,et al. Relationship between post-operative cognitive dysfunction and regional cerebral oxygen saturation and β-amyloid protein[J].J Zhejiang Univ Sci B,2014,15(10):870-878.
14.Li X1,Wen DX,Zhao YH,et al.Increase of beta-amyloid and C-reactive protein in liver transplant recipients with postoperative cognitive dysfunction[J]. Hepatobiliary Pancreat Dis Int,2013,12(4):370-376.
15.Xu G,Li LL,Sun ZT,et al.Effects of Dexmedetomidine on Postoperative Cognitive Dysfunction and Serum Levels of b-Amyloid and Neuronal Microtubule-Associated Protein in Orthotopic Liver Transplantation Patients[J]. Ann Transplant,2016 ,16(21):508-515.

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