右美托咪定复合麻醉对老年食道癌根治术患者术后谵妄的影响  

Effects of dexmedetomidine combined anesthesia on postoperative delirium in elderly patients undergoing radical resection of esophageal cancer

作　　者：周逸刚 陈建 陆忠辉 张桐硕 郑建 葛亚丽[3] ZHOU Yigang;CHEN Jian;LU Zhonghui;ZHANG Tongshuo;ZHENG Jian;GE Yali(Yangzhou University Medical College,Yangzhou,Jiangsu,225000;Jiangsu Armed Police Corps Hospital,Yangzhou,Jiangsu,225000;Jiangsu Subei people′s Hospital,Yangzhou,Jiangsu,225000)

机构地区：[1]扬州大学医学院,江苏扬州225000 [2]江苏省武警总队医院,江苏扬州225000 [3]江苏省苏北人民医院,江苏扬州225000

出　　处：《实用临床医药杂志》2020年第2期61-64,共4页Journal of Clinical Medicine in Practice

摘　　要：目的评价右美托咪定复合麻醉对老年食道癌根治术患者术后谵妄发生率的影响。方法选择择期在全麻下行根治术治疗的食道癌患者70例,采用随机数字表法分为对照组、右美托咪定组,每组35例。右美托咪定组麻醉诱导前经静脉泵注右美托咪定0.8μg/kg,输注时间15 min,随后持续静脉泵注右美托咪定0.4μg/(kg·h),输注至手术结束前30min,对照组给予等容量生理盐水。术后48 h内采用谵妄分级量表法-98修订版(DRS-R-98)评估谵妄的发生情况。麻醉诱导前(T0)、单肺通气1h(T1)、术毕(T2)、拔管时(T3)分别记录血氧饱和度(SpO2)、心率(HR)、平均动脉压(MAP);T0、T3、术后48h(T4),抽取颈内静脉球部血样2 mL,检测超敏C反应蛋白(hs-CRP)水平。结果与对照组比较,右美托咪定组术后谵妄发生率显著更低(P<0.05);与T0比较,2组T3、T4时点hs-CRP浓度均显著升高(P<0.05);右美托咪定组T3、T4时点hs-CRP浓度与对照组比较差异有统计学意义(P<0.05)。结论持续输注右美托咪定可显著降低老年食道癌根治术患者术后谵妄的发生率,其机制与稳定血流动力学、抑制脑部炎症反应有关。Objective To investigate the efficacy of dexmedetomidine combined anesthesia on postoperative delirium in elderly patients undergoing radical resection of esophageal cancer.Methods Seventy patients with selective radical resection of esophageal cancer were selected and randomly divided into dexmedetomidine group(n=35)and control group(n=35)by random number table method.The dexmedetomidine group was intravenously pumped 0.8μg/kg dexmedetomidine for 15 min before anesthesia induction,and was continuously infused at a speed rate of 0.4μg/(kg·h)until 30 min before surgery completion.Patients in the control group received the same dosage of saline in the same way.Delirium-rating Scale-98 Revised(DRS-R-98)was used to assess the occurrence of delirium within 48 hours after operation.Percutaneous oxygen saturation(SpO2),heart rate(HR)and mean arterial blood pressure(MAP)before anesthesia induction(T0),at 1 hour after single lung ventilation(T1),at the end of the operation(T2)and at the time point of tracheal extubation(T3),were recorded.Blood samples for 2 mL were collected from the jugular bulb before anesthesia induction(T0),tracheal extubation(T3)and at 48 h after operation(T4)to determine the serum concentrations of hypersensitive C reactive protein(hs-CRP).Results Compared with control group,the incidence of postoperative delirium was significantly decreased(P<0.05).Compared with T0,the concentrations of hs-CRP at T3 and T4 in the two groups increased(P<0.05);the concentrations of hs-CRP at T3 and T4 in dexmedetomidine group showed significant differences compared to the control group(P<0.05).Conclusion Continuous infusion of dexmedetomidine can significant decrease incidence of postoperative delirium in elderly patients undergoing radical resection of esophageal cancer.Its mechanism is related to stabilizing hemodynamics,and inhibiting inflammatory responses.

关 键 词：右美托咪定 全身麻醉 超敏C反应蛋白 食道癌根治术 术后谵妄 

分 类 号：R735.1[医药卫生—肿瘤]