摘要
目的探讨右美托咪定对老年腹腔镜胃肠肿瘤手术患者全身麻醉(全麻)苏醒期的影响。方法选择2017年3月至2019年2月在该院择期行腹腔镜下胃肠肿瘤手术的全麻患者100例,性别不限,年龄66~85岁,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,随机分为C组和D组,各50例。D组患者手术结束前40 min持续静脉泵注0.4μg/(kg·h)右美托咪定至手术结束,C组患者持续静脉泵注等容量等速率生理盐水。记录2组入室时(T 0)、拔管即刻(T 1)、拔管后5 min(T 2)、拔管后10 min(T 3)的心率(HR)、血压(BP)。比较2组患者麻醉药物的用量、术后呼吸恢复时间、睁眼时间、气管拔管时间、Richmond躁动-镇静评分(RASS)、谵妄发生率、谵妄持续时间、住院时间、3个月病死率。结果与C组相比,D组T 1、T 2、T 3时间点HR、BP显著降低,舒芬太尼、丙泊酚的用量明显减少,差异均有统计学意义(P<0.05);D组术后呼吸恢复时间、睁眼时间、气管拔管时间与C组相比,差异均无统计学意义(P>0.05);与C组相比,D组RASS评分明显降低,术后谵妄发生率明显下降,谵妄持续时间明显降低,住院时间明显缩短,差异均有统计学意义(P<0.05)。2组患者术后3个月病死率比较,差异无统计学意义(P>0.05)。结论手术结束前40 min持续泵注0.4μg/(kg·h)右美托咪定能维持老年患者行腹腔镜胃肠肿瘤手术全麻苏醒期的血流动力学稳定,减轻躁动,降低谵妄发生率。
Objective To investigate the effect of dexmedetomidine on general anesthesia recovery in elderly patients undergoing laparoscopic gastrointestinal tumor surgery.Methods A total of 100 cases of general anesthesia patients,regardless of gender,aged from 66 to 85 years,American Society of Anesthesiologists(ASA)gradingⅡ-Ⅲ,who underwent laparoscopic gastrointestinal tumor surgery in hospital from March 2017 to February 2019,were randomly divided into group C and group D,50 cases in each group.Patients in group D were continued intravenous injection of 0.4μg/(kg·h)dexmedetomidine 40 min before the end of surgery until the end of the operation.Group C patients were continued to recive a constant rate of normal saline.The heart rate(HR),blood pressure(BP)for both groups at the time entering the theater(T 0),immediately after extubation(T 1),5 min after extubation(T 2)and 10 min after extubation(T 3)were recorded.The dosage of anesthetics,postoperative respiratory recovery time,eye opening time,tracheal extubation time,Richmond agitation-sedation scale(RASS),delirium incidence rate,delirium duration,hospitalization time and 3-month mortality rate were compared between the two groups.Results Compared with group C,the HR and BP at the time points of T 1,T 2 and T 3 in group D were significantly lower,and the doses of sufentanil and propofol were significantly decreased,the differences were statistically significant(P<0.05).Compared with group C,there were no significant differences in postoperative respiratory recovery time,blink time and tracheal extubation time between group D(P>0.05).Compared with group C,RASS score was significantly lower,the incidence of postoperative delirium was significantly decreased,the duration of delirium was significantly decreased,and the length of hospital stay was significantly reduced in group D,the differences were statistically significant(P<0.05).There was no significant difference in mortality between the two groups after 3 months(P>0.05).Conclusion Continuous infusion of 0.4μg/(kg·h)dexmedetomidine 40 min before the end of operation can maintain hemodynamic stability,reduce agitation and delirium incidence in elderly patients undergoing laparoscopic gastrointestinal tumor surgery during general anesthesia recovery period.
作者
周俊妤
ZHOU Junyu(Department of Anesthesiology,Beibei District Traditional Chinese Medicine Hospital of Chongqing,Chongqing 400700,China)
出处
《现代医药卫生》
2020年第4期512-515,共4页
Journal of Modern Medicine & Health
关键词
右美托咪定
腹腔镜手术
全身麻醉
苏醒
胃肠肿瘤
谵妄
老年人
Dexmedetomidine
Laparoscopic surgery
General anesthesia
Recovery
Gastrointestinal tumor
Delirium
Elderly
作者简介
周俊妤(1985—),硕士研究生,主治医师,主要从事临床麻醉研究。
