右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响

doi:10.3969/j.issn.1006-6233.2022.06.029

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摘要 目的: 探讨右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响。方法: 选取拟行腹腔镜肝切除术的老年患者100例,将患者随机分为试验组和空白组,每组50例。试验组静脉泵注右美托咪定0.2ug·kg^-1·h^-1,维持至手术结束前30min。空白组以同样方式泵注等量0.9%生理盐水。记录患者入室(T₀)、切皮(T₁)、开始切肝(T₂)、切肝完成(T₃)、术毕(T₄)的MAP、HR。持续监测局部脑氧饱和度(regional cerebral oxygen saturation,rSO₂),计算术中rSO₂平均值(rSO₂)、术中rSO₂最小值(rSO_2min)、rSO₂较基础值下降的最大百分比(rSO_2%max)。分别于术前1d、术后第1、3、7天进行MMSE评分,记录两组患者术后认知功能障碍(postoperative cognitive disfunction,POCD)的发生情况及住院时间。记录两组患者清醒时间、拔管时间及恢复期不良反应发生率。结果: 试验组在T₂、T₃的MAP明显高于空白组,HR明显低于空白组,比较差异有统计学意义(P<0.05)。在T₂~T₄时间点,试验组rSO_2%max明显低于空白组,比较差异有统计学意义(P<0.05);两组患者rSO_2min和rSO₂比较差异无统计学意义(P>0.05)。试验组POCD发生率明显少于空白组,比较差异有统计学意义(P<0.05)。试验组住院时间较空白组明显减少,比较差异有统计学意义(P<0.05)。两组患者清醒时间、拔管时间比较差异无统计学意义(P>0.05)。试验组麻醉恢复期不良反应发生率均显著低于空白组(P<0.05)。结论: 右美托咪定能维持患者循环系统的稳定,使脑氧处于供需平衡状态,不影响恢复质量,术后并发症少,对术后认知功能无影响,降低POCD发生率。

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关键词 ：右美托咪定, 肝切除术, 脑氧饱和度, 术后认知, 老年

Abstract：Objective: To investigate the impacts of dexmedetomidine on cerebral oxygen saturation and postoperative cognition in elderly patients undergoing laparoscopic hepatectomy. Methods: One hundred elderly patients who were to undergo laparoscopic hepatectomy were selected, and the patients were randomly divided into experimental group and blank group using the random number table method, with 50 cases in each group. In the experimental group, dexmedetomidine 0.2ug·kg^-1·h^-1 was pumped intravenously and maintained until 30 min before the end of the operation, and in the blank group, the same amount of 0.9% saline was pumped in the same way. The MAP and HR were recorded at room entry (T₀), skin incision (T₁), start of liver incision (T₂), completion of liver incision (T₃), and end of surgery (T₄). Regional cerebral oxygen saturation (rSO₂) was monitored continuously and the mean intraoperative rSO₂ (rSO₂), the minimum intraoperative rSO₂ value (rSO_2min), and the maximum percentage decrease of rSO₂ from the basal value (rSO_2%max) were calculated. The MMSE scoring were performed at 1 d before surgery, 1, 3 and 7 d after surgery, and the occurrence of postoperative cognition disorders (POCD) and the number of days of hospitalization were recorded in the two groups, respectively. The time of awakening, time of extubation and the incidence of adverse reactions during the recovery period were recorded. Results: The MAP of the experimental group was significantly greater than that of the blank group at T₂ and T₃, and the HR was significantly lower than that of the blank group, and the difference was statistically significant (P<0.05). At the time points from T₂ to T₄, the rSO_2%max of the experimental group was significantly lower than that of the blank group, and the difference was statistically significant(P<0.05); there was no statistically significant difference in the rSO_2min and rSO₂ comparison between the 2 groups of patients (P>0.05). The incidence of POCD in the experimental group was significantly less than that in the blank group, and the difference was statistically significant (P<0.05). The hospitalization time of the experimental group was significantly shorter than that of the blank group and the difference was statistically significant (P<0.05). There was no statistic significance in revival time and the time for withdrawing the catheter between the 2 groups(P>0.05). The incidence of adverse reactions during the awakening period was significantly lower in the experimental group than in the blank group (P<0.05). Conclusion: Dexmedetomidine can maintain the stability of the patient's circulatory system, keep brain oxygen in a balanced state of supply and demand without affecting the recovery quality. It has few postoperative complications, has no effect on postoperative cognitive function, and it reduces the incidence of POCD.

Key words： Dexmedetomidine Hepatectomy Cerebral oxygen saturation Postoperative awareness Elderly patients

基金资助:河北省承德市科学技术研究与发展计划项目,(编号:201904A044)

通讯作者: 李建玲

引用本文:

郭云飞, 魏雯欣, 胡楠楠, 李明辉, 李建玲. 右美托咪定对腹腔镜肝切除术老年患者脑氧饱和度及术后认知的影响[J]. 河北医学, 2022, 28(6): 1011-1015.
GUO Yunfei, WEI Wenxin, HU Nannan, et al. The Impacts of Dexmedetomidine on Cerebral Oxygen Saturation and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Hepatedctomy. HeBei Med, 2022, 28(6): 1011-1015.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.06.029 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I6/1011

[1] Glassberg MB,Ghosh S,Clymer JW,et al.Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases:a systematic review and meta-analysis[J].World Surg Oncol,2019,17(1):98.
[2] Hoen L,Pfeffer D,Zapf R,et al.Association of drug application and hydration status in elderly patients[J].Nutrients,2021,13(6):1929.
[3] 徐四七,刘宁,胡胜红,等.利多卡因复合右美托咪定对腹腔镜全子宫切除患者术后恢复质量的影响[J].临床麻醉学杂志,2021,37(12):1275-1279.
[4] 张桂华.右美托咪定对老年腹部手术患者术后认知功能恢复的影响分析[J].吉林医学,2021,42(9):2178-2179.
[5] 颜燕琳,郑晓春.术中局部脑氧饱和度预测术后认知功能障碍的研究进展[J].创伤与急诊电子杂志,2020,8(3):141-145.
[6] Ahmad B,Turkmani K,Marwa ME,et al.Perioperative liver function after hepatectomy in a tertiary university hospital in damascus[J].Asian Pac Cancer Prev,2017,18(8):2109-2113.
[7] 张新科,司小萌,郭培霞.右美托咪定对老年病人胃癌根治术术后炎症因子及认知功能的影响[J].安徽医药,2019,23(11):2266-2270.
[8] Wang X,Feng K,Liu H,et al.Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery:a prospective cohort study[J].Trials,2019,20(1):504.
[9] Holmgaard F,Vedel AG,Rasmussen LS,et al.The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery:a secondary analysis of a randomised trial[J].Br Anaesth,2019,123(2):196-205.
[10] 于健,单士强,聂宇,等.右美托咪定改善老年患者术后认知功能及脑氧代谢适宜剂量的研究[J].中国现代医学杂志,2019,29(11):117-121.
[11] 雷华娟,滕永杰,周启,等.右美托咪定对颅内动脉瘤栓塞术患者局部脑氧饱和度和脑功能的影响[J].中国药房,2021,32(7):865-869.
[12] Saravana-Bawan B,Warkentin LM,Rucker D,et al.Incidence and predictors of postoperative delirium in the older acute care surgery population:a prospective study[J].Can Surg,2019,62(1):33-38.