摘要目的 探讨右美托咪定对老年患者腰椎术全麻镇痛以及术后认知功能的临床效果.方法 选取2016年1月至12月在我院采取手术治疗的188例腰椎手术患者进行分析,随机将其分为对照组(88例)和研究组(100例),研究组患者先予以1.0 μg/kg负荷剂量右美托咪定,15 min后,持续泵注0.3 μg· kg-1·h-1,对照组患者采取等量生理盐水持续泵入,并比较两组患者术中镇痛药物使用量以及疼痛和认知功能改变情况. 结果 研究组患者术中瑞芬太尼、芬太尼和丙泊酚等药物使用剂量少于对照组(P＜0.05);研究组患者术后简易智力状态检查量表(MMSE)评分[(28.0±1.3)分和(26.1±2.5)分]和疼痛视觉模拟评分法(VAS)评分[(2.6±0.5)分和(4.5±1.2)分]优于对照组患者(t=-6.6484和4.9398,均P=0.0000). 结论 术中使用右美托咪定不仅有助于减少老年腰椎手术患者围术期镇痛和镇静药物使用剂量,同时还能减轻术后疼痛以及改善术后认知功能.

abstractsObjective To investigate the clinical effects of Dexmedetomidine on analgesia and postoperative cognitive function in elderly patients with lumbar spine surgery.Methods The patients were randomly divided into the control group (n=88) and the study group (n=100).The patients in the study group were treated with Dexmedetomidine at a loading dose of 1.0 μg/kg for 15 min,and 0.3 μg · kg-1 · h 1 was continuously pumped.The anesthetic mode and drugs in the control group were similar to those in study group,except that Dexmedetomidine in the study group was replaced with physiological saline in the control group.Intraoperatively used dose of analgesic drugs,and pain and cognitive function changes were compared between the two groups.Results The intraoperatively used doses of Remifentanil,Fentanyl and propofol were significantly lower in the study group than in the control group (P＜0.05).The VAS scores were markedly lower in the study group than in the control group (2.6±0.5 vs.4.5± 1.2,t=4.9398,P=0.0000).The MMSE scores were higher in the study group than in the control group (28.0 ± 1.3 vs.26.0 ± 2.5,t =-6.6484,P=0.0000).Conclusions Intraoperative use of Dexmedetomidine for treatment of the elderly patients with lumbar surgery will not only reduce the perioperatively used dose of analgesic and sedative drug,but also reduce postoperative pain and improve postoperative cognitive function.