远隔缺血预处理对食管癌根治术老年患者全身麻醉苏醒期躁动及术后早期康复的改善作用
摘要
目的观察远隔缺血预处理(RIPC)对食管癌根治术老年患者全身麻醉苏醒期躁动及术后早期康复的改善作用。方法择期接受食管癌根治术的老年患者60例,采用随机数字表法将其分为RIPC组(R组)和对照组(C组),每组30例。所有患者麻醉方法及苏醒期躁动的常规预防措施相同。R组在麻醉诱导后5 min于患者右上肢上臂采用测压袖带给予3个循环的5 min缺血(袖带充气,压力≥200 mm Hg)及5 min再灌注(袖带放气至0 mmHg)处理;C组将袖带绑于患者右上肢,但不进行充气及放气操作。(1)两组患者在麻醉结束后0、5、10、15、20、30、60min采用三分法进行苏醒期躁动评分,躁动评分≥1分记为患者发生躁动,计算两组患者不同时间点的躁动发生率。(2)使用FORE-SIGHT脑氧饱和度监测仪监测患者的局部脑氧饱和度(r SO_2),分别于麻醉前10 min(T_0)、麻醉后10 min(T_1)、手术开始前10 min(T_2)、手术开始后10 min(T_3)、手术开始后30 min(T_4)、手术开始后60 min(T_5)、术毕前10 min(T_6)及术毕时(T_7)记录患者的r SO_2。(3)分别于术后第1天和第2天采用康复质量评分量表-15(QoR-15)评估患者术后早期康复质量。(4)监测两组患者麻醉苏醒期嗜睡、呼吸抑制、窦性心动过缓、窦性心动过速、低血压、高血压、恶心、呕吐等不良事件的发生情况。结果 (1)与C组患者相比,R组麻醉结束后5、10、15、20min时躁动评分为3分的例数明显减少(P均<0.05),R组麻醉结束后10 min时的躁动发生率明显降低(P<0.05)。(2)与C组患者相比,R组T_3～T_5时r SO_2均显著升高(P均<0.05)。与T_0时相比,两组患者T_1～T_2及T_6～T_7时r SO_2均显著升高(P均<0.05),而C组患者T3～T5时r SO_2均显著降低(P均<0.05),R组患者T_4～T_5时r SO_2均显著升高(P均<0.05)。(3)R组患者术后第1天和第2天的QoR-15评分分别为(115.5±6.6)、(128.2±7.6)分,C组分别为(91.4±7.9)、(103.5±8.2)分,两组相比,P均<0.05。(4)两组患者麻醉苏醒期嗜睡、呼吸抑制、窦性心动过缓、窦性心动过速、高血压、低血压、恶心、呕吐等不良事件的发生例数相比,P均>0.05。结论 RIPC可有效降低食管癌根治术老年患者全身麻醉苏醒期躁动发生率及躁动评分,提升患者术中r SO_2,有利于患者术后早期康复。
引文
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[3]Pei H,Zhou C. Cardiac protection by remote ischemic preconditioning in patients with diabetes Status[J]. Int J Cardiol,2018,271:53.
[4]Li C,Xu M,Wu Y,et al. Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofolremifentanil anesthesia:a randomized controlled study[J]. Anesthesiology,2014,121(2):249-259.
[5]Messieha Z. Prevention of sevoflurane delirium and agitation with propofol[J]. Anesth Prog,2013,60(2):67-71.
[6]Meier DE. Pain as a cause of agitated delirium[J]. Arch Intern Med,2012,172(15):1130.
[7]Oh ES,Fong TG,Hshieh TT,et al. Delirium in older persons:advances in diagnosis and treatment[J]. JAMA,2017,318(12):1161-1174.
[8]Zhou D,Ding J,Ya J,et al. Remote ischemic conditioning:a promising therapeutic intervention for multi-organ protection[J].Aging(Albany NY),2018,10(8):1825-1855.
[9]吴昊,张雷,程新琦,等.丙泊酚不同镇静深度对体外循环下心脏瓣膜置换术患者术后谵妄的影响:与脑氧饱和度的关系[J].中华麻醉学杂志,2017,37(10):1163-1166.
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