右美托咪定对老年高血压患者围术期血流动力学和术后认知功能的影响：随机对照试验
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Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients
背景与目的
术后认知功能障碍是术后精神病的常见临床表现。它常发生于心脏手术、髋关节置换术，下颌骨骨折及其他手术后的患者。右美托咪定具有镇静、镇痛、抗焦虑作用，并可抑制交感神经活动及维持血液动力学稳定，有助于减少麻醉药物的用量，同时可轻微地抑制呼吸。有文献报道，术前给予右美托咪定用于镇静可降低患者术后急性谵妄的发生率。但目前尚无关于右美托咪定对老年原发性高血压患者术后认知功能影响研究的报道。
方 法
本研究是一项前瞻性、单中心、双盲对照的临床试验。老年患者年龄为60至80岁之间，且被诊断为原发性高血压的时间为1年或更长时间，将其随机分为2组。观察组给予负荷剂量的右美托咪定0.8μg/ kg，泵注时间超过10分钟。对照组在麻醉诱导前10分钟内泵注相同体积的生理盐水。将微量状态检查和白细胞介素-6、肿瘤坏死因子α及C-反应蛋白的水平作为主要结局指标。 将患者的基础值按组进行汇总，并使用卡方检验和
Fisher精确检验对其进行比较，连续变量采用双样本t检验或Wilcoxon秩和检验进行比较。采用重复测量的方差分析对两组的结局指标进行比较。
结 论
本研究的目地是探讨右美托咪定对术后心肌损伤和术后认知功能障碍的影响，探 讨炎症因子与术后认知功能的关系。通过这项研究，我们期望找到一种适合老年高血压患者的麻醉方法，以减轻其术后不良反应。
原始文献摘要
Du X , Yu J , Mi W . The effect of dexmedetomidine on the perioperative hemodynamics and postoperative cognitive function of elderly patients with hypertension: Study protocol for a randomized controlled
trial. Medicine (Baltimore).
INTRODUCTION:
Cognitive dysfunction after surgery, a common clinical manifestation of postoperative psychonosema. It usually occurs after heart surgery, hip replacement, mandibular fractures, and other major operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic effect, inhibits the sympathetic activity, maintains hemodynamic balance, helps reduce the amount of anesthetic agents, and relatively slightly depresses respiration. Preoperative administration of dexmedetomidine for sedation has been reported to reduce the incidence of acute postoperative delirium. But currently there is no study on the effect of dexmedetomidine on the postoperative cognitive function of elderly patients with essential
hypertension.
METHODS/DESIGN:
This study is a prospective, single-center, double-blind controlled clinical trial. Elderly patients aged between 60 and 80 years old, diagnosed with primary hypertension for 1 year or longer will be included, and randomized into 2 groups. Patients in observational group will be given a loading dose of dexmedetomidine at 0.8 μg/kg, pumped for over 10 minutes. Although patients in control group will be pumped of the same volume of normal saline within 10 minutes, before the induction of anesthesia. Minimental state examination and levels of interleukin-6, tumor necrosis factor alpha, and C-reactive protein will be set as primary endpoints. Baseline characteristics of patients will be summarized by groups and compared using Chi-square or Fisher exact tests for categorical variables and 2-sample t tests or Wilcoxon rank sum test for the continuous variables. Repeated measurement analysis of covariance model will also be used for the comparison of endpoints between 2 groups.
CONCLUSION:
The present study is designed to investigate the effect of the application of dexmedetomidine on postoperative myocardial injury and
postoperative cognitive dysfunction, also to explore the association between inflammatory factors and postoperative cognitive function. With this study, we are expecting to find out an appropriate anesthesia method for elderly people with hypertension to alleviate the postoperative adverse effects caused by medical treatments.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
编辑：代东君 审校：李华宇