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Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients
背景與目的
術(shù)后認知功能障礙是術(shù)后精神病的常見臨床表現(xiàn)。它常發(fā)生于心臟手術(shù)、髖關(guān)節(jié)置換術(shù)，下頜骨骨折及其他手術(shù)后的患者。右美托咪定具有鎮(zhèn)靜、鎮(zhèn)痛、抗焦慮作用，并可抑制交感神經(jīng)活動及維持血液動力學(xué)穩(wěn)定，有助于減少麻醉藥物的用量，同時可輕微地抑制呼吸。有文獻報道，術(shù)前給予右美托咪定用于鎮(zhèn)靜可降低患者術(shù)后急性譫妄的發(fā)生率。但目前尚無關(guān)于右美托咪定對老年原發(fā)性高血壓患者術(shù)后認知功能影響研究的報道。
方 法
本研究是一項前瞻性、單中心、雙盲對照的臨床試驗。老年患者年齡為60至80歲之間，且被診斷為原發(fā)性高血壓的時間為1年或更長時間，將其隨機分為2組。觀察組給予負荷劑量的右美托咪定0.8μg/ kg，泵注時間超過10分鐘。對照組在麻醉誘導(dǎo)前10分鐘內(nèi)泵注相同體積的生理鹽水。將微量狀態(tài)檢查和白細胞介素-6、腫瘤壞死因子α及C-反應(yīng)蛋白的水平作為主要結(jié)局指標。 將患者的基礎(chǔ)值按組進行匯總，并使用卡方檢驗和
Fisher精確檢驗對其進行比較，連續(xù)變量采用雙樣本t檢驗或Wilcoxon秩和檢驗進行比較。采用重復(fù)測量的方差分析對兩組的結(jié)局指標進行比較。
結(jié) 論
本研究的目地是探討右美托咪定對術(shù)后心肌損傷和術(shù)后認知功能障礙的影響，探 討炎癥因子與術(shù)后認知功能的關(guān)系。通過這項研究，我們期望找到一種適合老年高血壓患者的麻醉方法，以減輕其術(shù)后不良反應(yīng)。
原始文獻摘要
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.
麻醉學(xué)文獻進展分享
貴州醫(yī)科大學(xué)高鴻教授課題組
編輯：代東君 審校：李華宇
