右美托咪定联合瑞芬太尼对结肠癌患者术后认知功能及血流动力学的影响  

Effects of Dexmedetomidine Combined with Remifentanil on Postoperative Cognition and Hemodynamics in Patients Underwent Colon Cancer

作　　者：屈惠[1] 杨怡[1] 吉恩秀[1] 魏揠琴[1] 

机构地区：[1]四川省人民医院城东病区麻醉科,成都610110

出　　处：《中国药房》2017年第8期1101-1104,共4页China Pharmacy

摘　　要：目的:探讨右美托咪定联合瑞芬太尼对结肠癌患者术后认知功能和血流动力学的影响及安全性。方法:选取我院2013年6月-2016年4月拟行结肠癌术患者100例,按随机数字表法分为对照组和观察组,各50例。对照组患者给予注射用盐酸瑞芬太尼2~4μg/kg麻醉诱导,维持剂量为0.5~2μg·kg/min;观察组患者给予盐酸右美托咪定注射液0.5μg/kg+瑞芬太尼2~4μg/kg麻醉诱导,维持剂量为盐酸右美托咪定注射液0.4μg·kg/h+注射用盐酸瑞芬太尼0.5~2μg·kg/min。观察两组患者术后1、2、3 d的简易智力状态检查量表(MMSE)评分及认知功能障碍(POCD)发生率,并记录不良反应发生情况。结果:观察组患者术后1、2、3 d POCD发生率分别为16.0%、4.0%、6.0%,显著低于对照组的36.0%、12.0%、10.0%,差异均有统计学意义(P<0.05)。两组患者术后1、3 d MMSE评分比较,差异无统计学意义(P>0.05);术后2 d,观察组患者MMSE评分显著高于对照组,差异有统计学意义(P<0.05)。两组患者术后1、2、3 d的血流动力学指标及血压增高、肌颤、恶心呕吐等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:右美托咪定联合瑞芬太尼对结肠癌患者术后POCD具有明显的改善作用,对患者术后的血流动力学影响较小,安全性较好。OBJECTIVE： To explore the effects and safety of dexmedetomidine combined with remifentanil on postoperative cognition and hemodynamics in patients underwent colon cancer surgery. METHODS： One hundred undergoing colon cancer surgery in our hospital during Jun. 2013-Apr. 2016 were selected and divided into control group and observation group according to random number table, with 50 cases in each group. Control group was given Remifentanil hydrochloride for injection 2-4 μg/kg for anesthesia induction, with maintenance dose of 0.5-2 μg·kg/min; observation group was treated with Dexmedetomidine hydrochloride for injection 0.5 μg/kg and remifentanil 2-4 μg/kg for anesthesia induction, with maintenance dose of Dexmedetomidine hydrochloride for injection 0.4μg·kg/h＋Remifentanil hydrochloride for injection 0.5-2 μg·kg/min. MMSE score and the incidence of postoperative cognitive dysfunction （POCD） were observed in 2 groups 1, 2, 3 d after surgery, and the occurrence of ADR was recorded. RESULTS： The incidence of POCD in observation group 1, 2, 3 d after surgery were 16.0%, 4.0%, 6.0%, which was significantly higher than 36.0%, 12.0%, 10.0% of control group, with statistical significance （P〈0.05）. There was no statistical significance in MMSE score between 2 groups 1, 3 d after operation （P〉0.05）. 2 d after surgery, MMSE score of observation group was significantly higher than that of control group, with statistical significance （P〈0.05）. There was no statistical significance in hemodynamic indexes, the incidence of ADR as blood pressure increasing, amyostasia, nausea and vomiting between 2 groups 1, 2, 3 d after surgery （P〉0.05）. CONCLUSIONS： Dexmedetomidine combined with remifentanil can significantly improve postoperative POCD in patients underwent colon cancer surgery and have little effect on hemodynamics with good safety.

关 键 词：右美托咪定 瑞芬太尼 结肠癌 术后认知功能障碍 血流动力学 

分 类 号：R614.2[医药卫生—麻醉学] R735.35[医药卫生—外科学]