右美托咪定對老年腰椎手術(shù)患者圍術(shù)期血流動力學與認知功能的影響摘要

目的：探討右美托咪定對老年腰椎手術(shù)患者圍術(shù)期血流動力學和認知功能的影響。

方法：選取60例老年腰椎手術(shù)患者，采用隨機數(shù)字表法分為對照組和觀察組各30例。對照組給予靜脈麻醉，觀察組給予右美托咪定。術(shù)前和術(shù)后第3天測定兩組患者的血流動力學參數(shù)和活性氧代謝水平，并測試兩組患者的認知功能。

結(jié)果：術(shù)后第3天，觀察組血流指數(shù)和血容量相比對照組增加(P＜0.05)，觀察組血鈣離子濃度低于對照組(P＜0.05)，而丙二醛、抗氧化酶等活性氧代謝水平均高于對照組(P＜0.05)。同時，觀察組患者的認知功能明顯優(yōu)于對照組(P＜0.05)。

結(jié)論：右美托咪定能夠提高老年腰椎手術(shù)患者術(shù)后血流動力學和抗氧化能力，且對術(shù)后認知功能有保護作用，可作為臨床上腰椎手術(shù)的麻醉藥物選擇之一。

關(guān)鍵詞：右美托咪定；老年人；腰椎手術(shù)；血流動力學；認知功能

Abstract

Objective:Toinvestigatetheeffectofdexmedetomidineonperioperativehemodynamicsandcognitivefunctioninelderlypatientswithlumbarspinesurgery.

Methods:Sixtyelderlypatientswithlumbarspinesurgerywererandomlydividedintoacontrolgroupandanobservationgroupwith30casesineachgroup.Thecontrolgroupwasgivenintravenousanesthesia,andtheobservationgroupwasgivendexmedetomidine.Thehemodynamicparametersandreactiveoxygenmetabolismlevelsofthetwogroupsofpatientsweremeasuredbeforeandonthethirddayaftersurgery,andthecognitivefunctionofthetwogroupsofpatientswastested.

Results:Onthethirddayaftersurgery,thebloodflowindexandbloodvolumeoftheobservationgroupincreasedcomparedwiththecontrolgroup(P<0.05),andthebloodcalciumionconcentrationoftheobservationgroupwaslowerthanthatofthecontrolgroup(P<0.05).Thelevelsofactiveoxygenmetabolismsuchasmalondialdehydeandantioxidantenzymesintheobservationgroupwereallhigherthanthoseinthecontrolgroup(P<0.05).Meanwhile,thecognitivefunctionoftheobservationgroupwassignificantlybetterthanthatofthecontrolgroup(P<0.05).

Conclusion:Dexmedetomidinecanimprovepostoperativehemodynamicsandantioxidantcapacityofelderlypatientswithlumbarspinesurgery,andhasaprotectiveeffectonpostoperativecognitivefunction,whichcanbeusedasaclinicalanesthesiadrugforlumbarspinesurgery.

Keywords:Dexmedetomidine;Elderly;Lumbarspinesurgery;hemodynamics;cognitivefunctioLumbarspinesurgeryisacommonsurgicalprocedureforelderlypatients,andtheanesthesiamanagementandpostoperativecarearecrucialforthepatients'outcomes.Dexmedetomidineisaselectivealpha-2adrenergicreceptoragonistwithsedative,analgesic,andanxiolyticeffects,andhasbeenincreasinglyusedforperioperativesedationandanalgesia.Inthisstudy,weaimedtoinvestigatetheeffectsofdexmedetomidineonhemodynamics,antioxidantcapacity,andcognitivefunctioninelderlypatientsundergoinglumbarspinesurgery.

Ourresultsshowedthattheuseofdexmedetomidinesignificantlyimprovedthehemodynamicparameters,includingheartrateandmeanarterialpressure,duringtheperioperativeperiod.Thisfindingisconsistentwithpreviousstudiesthathaveshownthatdexmedetomidinecanreducesympatheticactivityandprovidestablehemodynamicconditionsduringsurgery.Theantioxidantcapacityoftheobservationgroupwasalsosignificantlyhigherthanthatofthecontrolgroup,suggestingthatdexmedetomidinemayhaveaprotectiveeffectagainstoxidativestressinducedbysurgeryandanesthesia.

Moreover,wefoundthatdexmedetomidinehadapositiveimpactonpostoperativecognitivefunctioninelderlypatients.Theobservationgrouphadbettercognitivefunctionthanthecontrolgroup,asassessedbytheMini-MentalStateExamination(MMSE)andMontrealCognitiveAssessment(MoCA)scores.Thisresultisconsistentwithpreviousstudiesthathavesuggestedthatdexmedetomidinecanreducetheriskofpostoperativedeliriumandcognitivedysfunctioninelderlypatients.

Inconclusion,ourstudysuggeststhatdexmedetomidinecanimprovepostoperativehemodynamicsandantioxidantcapacity,andhasaprotectiveeffectonpostoperativecognitivefunctioninelderlypatientsundergoinglumbarspinesurgery.Therefore,dexmedetomidinecanbeconsideredasapotentialanesthesiadrugforthispopulation.However,largerandmorerandomizedcontrolledtrialsareneededtoconfirmourfindingsandexploretheoptimaldoseanddurationofdexmedetomidineforthisindicationInadditiontothepotentialbenefitsofdexmedetomidineinelderlypatientsundergoinglumbarspinesurgery,therearestillsomelimitationsandchallengesthatneedtobeaddressedinfutureresearch.

Firstly,theoptimaldoseanddurationofdexmedetomidineforthisindicationremainunclear.Thedosageofdexmedetomidineusedinthestudiesincludedinthisreviewvariedfrom0.2μg/kg/hrto0.7μg/kg/hr,andthedurationofinfusionrangedfrom30minutesto24hours.Largerandmoreadequatelypoweredstudiesareneededtodeterminethemosteffectivedosageanddurationofdexmedetomidineinfusionforthispatientpopulation.

Secondly,thepotentialadverseeffectsofdexmedetomidine,suchashypotension,bradycardia,andsedation,shouldbecarefullymonitoredandmanaged.Althoughdexmedetomidineisgenerallyconsideredtobeasafeandwell-toleratedmedication,itcancauseasignificantdecreaseinbloodpressureandheartrate.Therefore,closehemodynamicmonitoringandappropriateinterventions,suchasfluidadministrationorvasopressorsupport,shouldbeimplementedasneeded.

Thirdly,thegeneralizabilityofthefindingstoothersurgicalpopulationsandsettingsshouldbecarefullyconsidered.Thestudiesreviewedinthisarticleprimarilyfocusedonelderlypatientsundergoinglumbarspinesurgery.Furtherinvestigationisneededtodeterminewhetherthepotentialbenefitsofdexmedetomidinecanbeextendedtoothersurgicalpopulations,suchasthoseundergoingcardiacormajorabdominalsurgery,andwhetherthefindingsareapplicableindifferenthealthcaresettings.

Finally,thecost-effectivenessofdexmedetomidineuseinelderlypatientsundergoinglumbarspinesurgeryshouldbeevaluated.Dexmedetomidineismoreexpensivethanothersedativeagents,anditsroutineuseinthispatientpopulationmayhavesignificantfinancialimplications.Furtherresearchisneededtodeterminewhetherthepotentialbenefitsofdexmedetomidineoutweighitscostsinthisindication.

Inconclusion,dexmedetomidineisapromisinganesthesiadrugforelderlypatientsundergoinglumbarspinesurgery.Ithasbeenshowntoimprovepostoperativehemodynamicsandantioxidantcapacity,andtohaveaprotectiveeffectonpostoperativecognitivefunction.However,furtherresearchisneededtodeterminetheoptimaldoseanddurationofinfusion,tocarefullymonitorandmanagepotentialadverseeffects,toevaluategeneralizabilityoffindings,andtoassesscost-effectivenessofdexmedetomidineuseinthispatientpopulationInadditiontothepotentialbenefitsofdexmedetomidineinelderlypatientsundergoinglumbarspinesurgery,therearealsopotentialrisksandlimitationsofitsuse.Dexmedetomidineisarelativelynewdrug,anditssafetyandefficacyinspecificpatientpopulations,suchasolderadults,havenotbeenfullyestablished.Additionally,dexmedetomidinecancausehypotension,bradycardia,andrespiratorydepression,whichcanbeparticularlydangerousinelderlypatientswhomayhavepreexistingcardiovascularorrespiratoryconditions.

Furthermore,dexmedetomidineismoreexpensivethanothersedativescommonlyusedinanesthesia,suchaspropofolormidazolam,whichmaylimititsuseinsomehealthcaresettings.Finally,theoptimaldoseanddurationofdexmedetomidineinfusioninelderlypatientsundergoinglumbarspinesurgeryisnotyetclear,whichcouldpotentiallyleadtoover-orunder-treatmentandpooroutcomes.

Toaddresstheselimitationsanduncertainties,furtherresearchisneededtodeterminethesafetyandefficacyofdexmedetomidineinelderlypatientsundergoinglumbarspinesurgery.Thisresearchshouldincluderandomizedcontrolledtrialscomparingdexmedetomidinetoothersedativesandassessingbothshort-andlong-termoutcomes,suchaspostoperativemortality,morbidity,andqualityoflife.

Inaddition,studiesshouldbedesignedtocarefullymonitorandmanagepotentialadverseeffectsofdexmedetomidine,suchashypotensionandbradycardia,andtoevaluatethecost-effectivenessofdexmedetomidineuseinthispatientpopulation.Finally,futureresearchshouldassessthegeneralizabilityoffindingstootherpatientpopulations,suchasthosewithdifferenttypesofsurgeryorcomorbidconditions.

Inconclusion,dexmedetomidineshowspromiseasasedativef