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
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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0.4μg/kg,继以0.4μg·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(T_0)、麻醉诱导后(T_1)、气管插管后(T_2)、切皮后(T_3)、气腹后5 min(T_4)、手术结束时(T_5)、拔管时(T_6)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,T_3～T_6时间点D组病人的心率减慢,T_2～T_6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。
Objective:To investigate the effects of dexmedetomidine on the postoperative cognitive dysfuction(POCD) and intraoperative hemodynamics in colorectal cancer elderly patients treated with laparoscopic resection.Methods:Forty 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 T_0(before anesthesia induction),T_1(after anesthesia induction),T_2(after intubation),T_3(after skin incision),T_4(after 5 minutes of pneumoperitoneum),T_5(at the end of surgery) and T_6(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.Results:Compared with group C,the HR slowed at T_3,T_4,T_5 and T_6,and the MAP decreased at T_2,T_3,T_4,T_5 and T_6 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).Conclusions:The 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.
Objective:To investigate the effects of dexmedetomidine on the postoperative cognitive dysfuction(POCD) and intraoperative hemodynamics in colorectal cancer elderly patients treated with laparoscopic resection.Methods:Forty 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 T_0(before anesthesia induction),T_1(after anesthesia induction),T_2(after intubation),T_3(after skin incision),T_4(after 5 minutes of pneumoperitoneum),T_5(at the end of surgery) and T_6(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.Results:Compared with group C,the HR slowed at T_3,T_4,T_5 and T_6,and the MAP decreased at T_2,T_3,T_4,T_5 and T_6 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).Conclusions:The 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.
引文
[1] DECRANE SK,SANDS L,ASHLAND M,et al.Factors associated with recovery from early postoperative delirium[J].J Perianesth Nurs,2011,26(4) :231.
[2] XY G,LI LL,SUN ZT,et al.Effect of dexmedetomidine on postoperative cognit-ive dysfunction in elderly patients after general anaesthesia:a meta-analysis[J].J Inter Med Res,2016,44(6):1182.
[3] DEINER S,LUO X,LIN HM,et al.Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery:a randomized clinical trial[J].JAMA Surg,2017,152(8):e171505.
[4] 杨悦,马铃,代玉婷,等.盐酸右美托咪定对开腹结直肠癌根治术患者围术期肺动态顺应性和外周血中TLR-2和TLR-4表达的影响[J].中国医科大学学报,2016,45(12):1077.
[5] 周翔,吴明春,宋晓阳,等.长时间后腹腔镜手术对脑氧供需平衡的影响[J].重庆医学,2012,41(3):260.
[6] 李兴,闻大翔,陈杰,等.老年患者术后认知功能障碍发生率及相关因素的多中心研究[J].临床麻醉学杂志,2009,25 (8):652.
[7] BEKKER AY,WEEKS EJ.Cognitive function after anaesthesia in the elderly [J].Best Practice Res Clin Anaesthesial,2003,17(2):259.
[8] LI Y,HE R,CHEN S,et al.Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy[J].Exp Ther Med,2015,10(5):1635.
[9] 汤莉莉,顾尔伟,张雷,等.右美托咪定对老年脆弱脑功能患者术后认知功能的影响[J].中华麻醉学杂志,2016,36(2):140.
[10] CARLA NC,CHRISTIANE CS,LOUISE LC,et al.Perturbation of ion channel conductance alters the hypnotic response to the ɑ2-adrenergic agonist dexmedetomidine in the locus coeruleus of the rat[J].Anesthesiology,1994,81(4):1527.
[11] 杨俊杰,陈玉军,于亮,等.右美托咪啶对创伤性脑损伤大鼠模型的神经保护作用实验研究[J].国际神经病学神经外科学杂志,2017,44(5):523.
[12] XU HY,FU GH,WU GS.Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy[J].Saudi J Biol Sci,2017,24(8):1771.
[13] TRZEPACZ PT,HOCHSTETLER H,WANG S,et al.Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults[J].BMC Geriatr,2015,15:107.
[14] KO KH,JUN IJ,LEE S,et al.Effective dose of dexmedetomi dine to induce adequate sedation in elderly patients under spinal anesthesia[J].Korean J Anesthesiol,2015,68(6):575.
[15] SHAMIM R,SRIVASTAVA S,RASTOGI A,et al.Effect of two different doses of Dexmedetomidine on stress response in laparoscopic pyeloplasty:a randomized prospective controlled study[J].Anesth Essays Res,2017,11(4):1030.
[16] INOUYE SK,WESTENDROP RG,SACZYNSKI JS.Delirium in elderly people[J].Lancet,2014,383(9920):911.
[17] CHEN C,HUANG P,LAI L,et al.Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer:a randomized clinical trial [J].Medicine,2016,95(29):e4295.
[2] XY G,LI LL,SUN ZT,et al.Effect of dexmedetomidine on postoperative cognit-ive dysfunction in elderly patients after general anaesthesia:a meta-analysis[J].J Inter Med Res,2016,44(6):1182.
[3] DEINER S,LUO X,LIN HM,et al.Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery:a randomized clinical trial[J].JAMA Surg,2017,152(8):e171505.
[4] 杨悦,马铃,代玉婷,等.盐酸右美托咪定对开腹结直肠癌根治术患者围术期肺动态顺应性和外周血中TLR-2和TLR-4表达的影响[J].中国医科大学学报,2016,45(12):1077.
[5] 周翔,吴明春,宋晓阳,等.长时间后腹腔镜手术对脑氧供需平衡的影响[J].重庆医学,2012,41(3):260.
[6] 李兴,闻大翔,陈杰,等.老年患者术后认知功能障碍发生率及相关因素的多中心研究[J].临床麻醉学杂志,2009,25 (8):652.
[7] BEKKER AY,WEEKS EJ.Cognitive function after anaesthesia in the elderly [J].Best Practice Res Clin Anaesthesial,2003,17(2):259.
[8] LI Y,HE R,CHEN S,et al.Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy[J].Exp Ther Med,2015,10(5):1635.
[9] 汤莉莉,顾尔伟,张雷,等.右美托咪定对老年脆弱脑功能患者术后认知功能的影响[J].中华麻醉学杂志,2016,36(2):140.
[10] CARLA NC,CHRISTIANE CS,LOUISE LC,et al.Perturbation of ion channel conductance alters the hypnotic response to the ɑ2-adrenergic agonist dexmedetomidine in the locus coeruleus of the rat[J].Anesthesiology,1994,81(4):1527.
[11] 杨俊杰,陈玉军,于亮,等.右美托咪啶对创伤性脑损伤大鼠模型的神经保护作用实验研究[J].国际神经病学神经外科学杂志,2017,44(5):523.
[12] XU HY,FU GH,WU GS.Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy[J].Saudi J Biol Sci,2017,24(8):1771.
[13] TRZEPACZ PT,HOCHSTETLER H,WANG S,et al.Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults[J].BMC Geriatr,2015,15:107.
[14] KO KH,JUN IJ,LEE S,et al.Effective dose of dexmedetomi dine to induce adequate sedation in elderly patients under spinal anesthesia[J].Korean J Anesthesiol,2015,68(6):575.
[15] SHAMIM R,SRIVASTAVA S,RASTOGI A,et al.Effect of two different doses of Dexmedetomidine on stress response in laparoscopic pyeloplasty:a randomized prospective controlled study[J].Anesth Essays Res,2017,11(4):1030.
[16] INOUYE SK,WESTENDROP RG,SACZYNSKI JS.Delirium in elderly people[J].Lancet,2014,383(9920):911.
[17] CHEN C,HUANG P,LAI L,et al.Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer:a randomized clinical trial [J].Medicine,2016,95(29):e4295.