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目的 探讨术前静脉输注右美托咪定对于老年患者全麻下经会阴前列腺穿刺术中血流动力学及术后短期认知功能的影响.方法 共纳入70例拟行全麻下经会阴前列腺穿刺活检的老年男性患者,随机分为右美托咪定组(D组)和对照组(C组),每组各35例,D组术前15 min静脉输注0.5μg/kg右美托咪定50 mL,C组给予等体积生理盐水.分别于术前1 d、术后1 d、术后3 d采用简易智能量表(MMSE)对两组患者的认知功能状态进行评估,同时记录用药前(T0)、气管插管时(T1)、手术开始时(T2)、手术开始后10 min(T3)两组患者的心率(HR)及平均动脉压(MAP)、手术时间、拔管时间、清醒时间及术后麻醉不良反应发生情况.结果 两组患者手术时间、拔管时间、清醒时间及术后麻醉不良反应方面差异无统计学意义,两组患者术后1 d和3 d的MMSE评分均低于术前1 d(P<0.05),但D组患者术后1 d及术后3 d的MMSE评分均显著高于C组(P<0.05).与T0相比,D组T2和T3时HR显著降低(P<0.05),T3时MAP显著降低(P<0.05);C组T1时HR、MAP显著升高(P<0.05),T2时MAP显著升高(P<0.05),而T3时HR显著降低(P<0.05).结论 术前静脉输注0.5μg/kg右美托咪定可减少老年患者全麻下经会阴前列腺穿刺术后认知功能障碍的发生,同时术中血流动力学更平稳且不增加苏醒时间及麻醉术后不良反应的发生率.“,”Objective To investigate the effects of preoperative intravenous infusion of dexmedetomidine on perioperative hemodynamics and early postoperative cognitive dysfunction (POCD) in elder patients who underwent ultrasound-guided transperineal prostate biopsy with general anesthesia. Methods A total of 70 elder male patients aged 65～90 years and scheduled for transperineal prostate biopsy were divided into two groups randomly. 35 patients received intravenous infusion of dexmedetomidine 0.5μg/kg (group D) and the other 35 patients received the same volume of normal saline (group C) in fifteen minutes before induction. Cognitive function was assessed on 1 day before operation, the 1st day and the 3rd day after operation using mini mental state examination (MMSE). The time of operation, extubation and awaking and anesthetic adverse reactions were recorded. HR and MAP were also recorded before infusion of dexmedetomidine (T0), intubation (T1), beginning of surgery (T2) and 10 minutes after the beginning (T3). Results There were no difference in the time of operation, extubation, awaking and the incidence of the adverse reactions. MMSE scores on the 1st and 3rd day after operation were lower than 1 day before operation in both groups, but group D was higher than group C (P<0.05). Compared with group C, HR and MAP on T1, T2, T3 in group D were significantly decreased (P<0.05). Compared with T0, HR on T2, T3 and MAP on T3 were decreased in group D (P<0.05). In group C, HR and MAP on T1, MAP on T2 were higher than that on T0 (P<0.05), but HR on T3 was lower (P<0.05). Conclusion Preoperative infusion of dexmedetomidine (0.5μg/kg) may lead to a more stable perioperative hemodynamics and decrease the incidence of POCD in elder patients ultrasound-guided transperineal prostate biopsy without extending awaking time and increasing the incidence of adverse reactions.