右美托咪定对老年病人腹腔镜肠癌根治术血流动力学及术后早期认知功能的影响

沈俊; 严康明; 周敏

doi:10.13898/j.cnki.issn.1000-2200.2019.03.019

右美托咪定对老年病人腹腔镜肠癌根治术血流动力学及术后早期认知功能的影响

Effect of dexmedetomidine on the intraoperative hemodynamics and early postoperative cognitive function in colorectal cancer elderly patients treated with laparoscopic surgery

摘要

摘要:
目的研究右美托咪定对老年病人腹腔镜肠癌根治术后早期认知功能以及血流动力学影响。
方法40例全凭静脉麻醉下择期行腹腔镜肠癌根治术老年病人，随机数字表法分为右美托咪定组（D组）和对照组（C组），每组20例。D组病人麻醉诱导前10 min经静脉输注右美托咪定0.4 μg/kg，继以0.4 μg·kg^-1·h^-1速率维持泵注，直至手术结束，C组使用相同方法给予等体积的0.9%氯化钠溶液。记录2组病人麻醉诱导前（T₀）、麻醉诱导后（T₁）、气管插管后（T₂）、切皮后（T₃）、气腹后5 min（T₄）、手术结束时（T₅）、拔管时（T₆）的心率、平均动脉压，记录2组病人术前1 d和术后1 d、5 d MMSE评分，统计术后1 d、5 d认知功能障碍发生率；记录麻醉药用量及术后不良反应情况。
结果与C组比较，T₃~T₆时间点D组病人的心率减慢，T₂~T₆时间点D组病人的平均动脉压降低（P < 0.01）；C组病人术后1 d MMSE评分较D组降低，术后1 d认知功能障碍发生率高于D组（P < 0.01）。D组病人术中丙泊酚、舒芬太尼用量较C组明显减少（P < 0.01），术中阿托品使用率高于C组（P < 0.05），术后寒战发生率较C组降低（P < 0.05）。
结论老年病人腹腔镜肠癌根治术全凭静脉麻醉辅助右美托咪定可改善术后认知功能，降低早期认知功能障碍的发生率，血流动力学稳定，不良反应少。

Abstract:
ObjectiveTo investigate the effects of dexmedetomidine on the postoperative cognitive dysfuction (POCD) and intraoperative hemodynamics in colorectal cancer elderly patients treated with laparoscopic resection.
MethodsForty colorectal cancer elderly patients scheduled by laparoscopic resection under total intravenous anesthesia were randomly divided into the dexmedetomidine group (group D, 20 cases) and control group (group C, 20 cases).The 0.4 μg/kg of dexmedetomidine was intravenously injected in the group D before 10 min of anesthesia induction, and which was maintained at the end of operation.The group C was treated with the same method as the group D with 0.9% normal saline.The mean arterial pressure (MAP) and heart rate (HR) in two groups at T₀ (before anesthesia induction), T₁ (after anesthesia induction), T₂ (after intubation), T₃ (after skin incision), T₄ (after 5 minutes of pneumoperitoneum), T₅ (at the end of surgery) and T₆ (at the time of extubation) were recorded.The Mini-Mental State Examination (MMSE) scores before operation and after 1 d and 5 d of operation, incidence rate of cognitive dysfunctions at postoperative 1 d and 5 d, dosage of anesthetics, and adverse reactions were compared between two groups.
ResultsCompared with group C, the HR slowed at T₃, T₄, T₅ and T₆, and the MAP decreased at T₂, T₃, T₄, T₅ and T₆ in group D (P < 0.01).The MMSE score in group C decreased compared with group D, and the incidence rate of POCD in group C was higher than that in group D at postoperative 1 d (P < 0.01).The intraoperative use dosage of propofol and sufentanil in group D significantly decreased compared with group C (P < 0.01), the intraoperative use rate of atropine in group D was higher than that in group C (P < 0.05), and the incidence rate of postoperative shivering in group D decreased compared with group C (P < 0.05).
ConclusionsThe total intravenous general anesthesia combined with dexmedetomidine can improve the postoperative cognitive function, decrease the incidence rate of POCD, stabilize the hemodynamics and decrease the adverse reaction in colorectal cancer elderly patients treated with laparoscopic resection.

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