右美托咪定对老年患者肺叶切除术后谵妄 的影响

Effect of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Pulmonary Lobectomy

摘要: 目的：观察右美托咪定对老年肺叶切除术患者术后谵妄(postoperative delirium, POD)发生风险及血清炎症因子水平的调控效应，为老年胸科手术围术期神经保护提供参考。方法：采用前瞻性随机对照研究，纳入2023年9月至2024年9月在大理大学第一附属医院择期行肺叶切除术的老年男性受试者60例，通过随机数字表法分为右美托咪定组(D组，n = 30)和对照组(C组，n = 30)。所有患者接受舒芬太尼、丙泊酚、顺苯磺酸阿曲库铵行麻醉诱导，D组在术中持续泵注右美托咪定(0.4 μg/(kg∙h)，术毕前30 min停药)，辅以丙泊酚、瑞芬太尼维持麻醉，C组单纯使用丙泊酚联合瑞芬太尼常规维持。分别在术后即刻(T1)、术后第1天(T2)、第3天(T3)、第5天(T4)采用Richmond躁动–镇静量表(RASS)联合意识模糊评估法(CAM)评估POD发生情况；术前及术后T3采集静脉血，应用酶联免疫吸附试验(ELISA)测定血清C反应蛋白(CRP)与白介素-6 (IL-6)浓度；同时记录围术期血流动力学参数及不良事件。结果：相较于C组，D组在T2、T3、T4时刻的POD发生率显著降低(P < 0.05)。两组术后血清CRP、IL-6水平均高于术前，但D组在术后T3时上述指标均明显低于C组(P < 0.05)。两组围术期血流动力学波动幅度及不良反应发生率差异无显著差异(P > 0.05)。结论：手术期间持续给予低剂量右美托咪定可显著减少老年男性肺叶切除患者术后谵妄发生，缓解围术期炎症反应，且不增加不良反应事件风险，安全性较好，可作为老年胸科手术患者围术期神经保护的一项可行策略。

Abstract: Objective: To observe the regulatory effects of dexmedetomidine on the risk of postoperative delirium (POD) and serum inflammatory factor levels in elderly patients undergoing lobectomy, and to provide references for perioperative neuroprotection in geriatric thoracic surgery. Methods: A prospective randomized controlled study was conducted. A total of 60 elderly male patients scheduled for elective lobectomy at the First Affiliated Hospital of Dali University from September 2023 to September 2024 were enrolled and equally divided into a dexmedetomidine group (Group D, n = 30) and a control group (Group C, n = 30) using a random number table method. All subjects received anesthesia induction with sufentanil, propofol, and cisatracurium besylate. Group D received continuous intraoperative infusion of dexmedetomidine (0.4 μg∙kg⁻¹∙h⁻¹, discontinued 30 min before the end of surgery) combined with propofol and remifentanil for maintenance, while Group C underwent conventional maintenance using propofol and remifentanil alone. POD episodes were assessed immediately after surgery (T1), and on postoperative days 1 (T2), 3 (T3), and 5 (T4) using the Richmond Agitation-Sedation Scale (RASS) combined with the Confusion Assessment Method (CAM). Venous blood samples were collected preoperatively and at T3 postoperatively; serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured via enzyme-linked immunosorbent assay (ELISA). Perioperative hemodynamic parameters and adverse events were also recorded. Results: Compared with Group C, the incidence of POD in Group D was significantly lower at T2, T3, and T4 (P < 0.05). Postoperative CRP and IL-6 levels in both groups were higher than preoperative values, but the levels of these indicators in Group D at T3 were significantly lower than those in Group C (P < 0.05). No statistically significant differences were observed between the two groups regarding perioperative hemodynamic fluctuations or the incidence of adverse events (P > 0.05). Conclusion: Continuous intraoperative infusion of low-dose dexmedetomidine can significantly reduce the occurrence of postoperative delirium, alleviate perioperative inflammatory responses, and does not increase the risk of adverse events in elderly male patients undergoing lobectomy. It exhibits good safety and may serve as a feasible strategy for perioperative neuroprotection in geriatric thoracic surgery.