Dex对行三孔法LRP术的高龄前列腺癌患者术后镇静情况、神经功能及脑氧代谢的影响  

Effects of DEX on sedation,neurological function and cerebral oxygen metabolism in elderly patients with prostate cancer undergoing LRP

作　　者：范之丹 邵静[1] 丁炜宏 FAN Zhi-dan;SHAO Jing;DING Wei-hong(Department of Anesthesiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China;Department of Urology, Huashan Hospital, Fudan University, Shanghai 200000, China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海201999 [2]复旦大学附属华山医院泌尿外科,上海200000

出　　处：《海南医学院学报》2020年第7期524-528,共5页Journal of Hainan Medical University

基　　金：上海市科学技术委员会科研计划项目(19ZR1408000)。

摘　　要：目的:研究右美托咪定用于行三孔法LRP术对高龄前列腺癌患者术后镇静效果,及其对神经功能及脑氧代谢的影响。方法:随机选取2016年8月~2019年12月于本院治疗行全身麻醉下行三孔法LRP术患者78例,按照随机数字表法分为对照组和观察组,每组39例。术中观察组给予静脉右美托咪定,对照组给予等量等速度生理盐水。对比两组手术前后认知功能指标(MoCA评分、POCD发生率)、神经功能指标(TGF-β1、NSE、IGF-1)、脑氧代谢指标(PaO 2、MAP、PaCO 2、rSO 2)变化,对比两组视觉模拟评分(VAS)、术后镇痛药物用量及按压镇痛泵的次数。对比两组不良反应发生率。结果:术前,两组认知功能指标、神经功能指标、脑氧代谢指标比较,差异无统计学意义(P>0.05),两组术后1、3 d,两组MoCA评分均明显降低,观察组MoCA评分明显高于对照组,观察组POCD发生率明显低于对照组;术后3 d,两组TGF-β1、IGF-1均降低,观察组TGF-β1、IGF-1明显高于对照组,两组NSE均升高,观察组NSE明显低于对照组,差异均具有统计学意义(P<0.05)。本研究中气腹建立后1 h两组PaCO 2和rSO 2均明显升高,术后6、12 h,观察组VAS评分均低于对照组,且镇痛泵药物用量及镇痛泵按压次数均明显少于对照组,差异均具有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:Dex对行三孔法LRP术的高龄前列腺癌患者术后镇静效果较好,对神经功能、脑氧代谢影响小,安全性较好。Objective:To study the sedative effect of dexmedetomidine in elderly patients with prostate cancer undergoing three hole LRP,and its effect on nerve function and brain oxygen metabolism.Methods:From August 2016 to December 2019,78 patients with LRP under general anesthesia in our hospital were randomly selected and divided into control group and observation group according to the random number table method,39 cases in each group.During the operation,the observation group was given dextromethoridine,while the control group was given the same amount of normal saline.The changes of cognitive function index(MoCA score,POCD incidence rate),neurological function index(TGF-β1,NSE,IGF-1),brain oxygen metabolism index(PaO 2,map,PaCO 2,rSO 2)before and after operation were compared between the two groups.The visual analogue score(VAS),the amount of analgesic drugs and the times of pressing the analgesic pump were compared between the two groups.The incidence of adverse reactions was compared between the two groups.Results:Before operation,there was no significant difference in cognitive function index,neurological function index and brain oxygen metabolism index between the two groups(P>0.05).On the first and third days after operation,MOCA score of the two groups was significantly lower,MOCA score of the observation group was significantly higher than that of the control group,POCD incidence of the observation group was significantly lower than that of the control group;on the third day after operation,TGF-β1 and IGF-1 of the two groups were significantly lower,TGF-β1 and IGF-1 of the observation group were significantly lower while NSE in the observation group was significantly lower than that in the control group(P<0.05).In this study,1 h after the establishment of pneumoperitoneum,PaCO 2 and rSO 2 in the two groups were significantly increased,6 h and 12 h after the operation,the VAS score of the observation group was lower than that of the control group,and the dosage of analgesic pump and the number of times of co

关 键 词：DEX LRP术 前列腺癌 镇静镇痛 神经功能 脑氧代谢 

分 类 号：R737.25[医药卫生—肿瘤] R614[医药卫生—临床医学]