右美托咪定联合瑞芬太尼对全身麻醉下髋关节置换术患者脑氧代谢、血流动力学和认知功能的影响

摘要 目的：瑞芬太尼、右美托咪定对全身麻醉下髋关节置换术患者的脑氧代谢、血流动力学和认知功能的影响。方法：选取2016年6月~2019年10月期间我院收治的100例行髋关节置换术的患者。采用随机数字表法分为对照组和研究组，各50例。对照组患者麻醉中予以瑞芬太尼，研究组则在对照组的基础上复合右美托咪定，比较两组患者血流动力学、脑氧代谢和认知功能情况，记录两组患者围术期间不良反应发生率。结果：两组手术开始后30 min（T1）~手术结束时（T2）时间点平均动脉压（MAP）、心率（HR）均呈下降趋势，但研究组高于对照组（P<0.05）。两组T1~T2时间点动脉血氧含量（CaO₂）、颈内静脉血氧含量（CjvO₂）均呈下降趋势，且研究组低于对照组（P<0.05）；两组T1~T2时间点颈静脉球部血氧饱和度（SjvO₂）呈升高趋势，且研究组高于对照组（P<0.05）。两组术前~术后7 d简明精神状态量表（MMSE）评分均呈下降后升高趋势（P<0.05）；研究组术后3 d、术后7 d MMSE评分高于对照组（P<0.05）。研究组术后3 d、术后7 d的认知功能障碍（POCD）发生率低于对照组（P<0.05）。两组不良反应发生率比较无差异（P>0.05）。结论：全身麻醉下髋关节置换术患者麻醉方案选用右美托咪定联合瑞芬太尼，可减轻血流动力学波动，维持脑氧供需平衡，可减少POCD发生风险，且安全性较好。

Effects of Dexmedetomidine and Remifentanil on Cerebral Oxygen Metabolism, Hemodynamics and Cognitive Function in Patients Undergoing Hip Replacement Under General Anesthesia

ABSTRACT Objective: To investigate the effects of remifentanil and dexmedetomidine on cerebral oxygen metabolism, hemodynamics and cognitive function in patients undergoing hip replacement under general anesthesia. Methods: 100 patients with hip replacement were selected from June 2016 to October 2019. The patients were divided into control group and study group, each with 50 cases. Remifentanil was given to the patients in the control group during anesthesia, while dexmedetomidine was given to the patients in the study group on the basis of the control group. The hemodynamics, cerebral oxygen metabolism and cognitive function of the two groups were compared, and the incidence of adverse reactions during perioperative period was recorded. Results: The mean arterial pressure (map) and heart rate (HR) of the two groups decreased from 30 minutes (T1) to the end of operation (T2), but the study group was higher than the control group (P<0.05). The arterial blood oxygen content (CaO₂2) and the internal jugular vein blood oxygen content (CjvO₂) in the two groups showed a downward trend, and the study group was lower than the control group (P<0.05). The jugular bulb blood oxygen saturation (SjvO₂) in the two groups showed an upward trend, and the study group was higher than the control group (P<0.05). The Concise mental state scale (MMSE) scores of the study group were higher than those of the control group (P<0.05). The incidence of Cognitive impairment (POCD) in the study group was lower than that in the control group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Dexmedetomidine combined with remifentanil can reduce the hemodynamic fluctuation, maintain the balance of cerebral oxygen supply and demand, reduce the risk of POCD, and have a good safety.