小剂量右美托咪定对腰椎融合术老年患者术后肠道功能恢复的影响  

Impacts of low-dose dexmedetomidine on postoperative intestinal function recovery in elderly patients undergoing lumbar spinal fusion

作　　者：肖玮[1] 李萌[1] 赵磊[1] 姚东旭[1] 张瑛[1] 徐娜[1] 王天龙[1] Xiao Wei;Li Meng;Zhao Lei;Yao Dongxu;Zhang Ying;Xu Na;Wang Tianlong(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,National Center for Clinical Research on Geriatric Diseases,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科国家老年疾病临床研究中心,北京100053

出　　处：《北京医学》2020年第3期225-228,共4页Beijing Medical Journal

基　　金：北京市属医院科研培育计划(PX2019031);首都医科大学宣武医院英才计划。

摘　　要：目的探讨小剂量右美托咪定(dexmedetomidine,DEX)对行腰椎融合术老年患者术后肠道功能恢复的影响。方法选择2017年11月1日至2018年11月1日首都医科大学宣武医院行择期腰椎融合术的患者64例,随机分为生理盐水组(对照组)和右美托咪定组(DEX组),每组32例。DEX组15 min内泵入DEX负荷量0.5μg/kg,随后以0.1μg/(kg·h)持续泵注至术毕前30 min。对照组给予等量生理盐水。术毕应用静脉自控镇痛。记录患者一般资料和手术情况,记录麻醉诱导前、试验干预前及手术结束前的MAP和HR。比较术后舒芬太尼总用药量、术后首次肠排气的时间和手术开始前,术毕即刻及术后24、48、72 h各时间点脂多糖(lipopolysaccharides,LPS)、TNF-α和CRP的水平。结果DEX组的术后首次排气时间显著短于对照组[(15.9±5.1)h比(21.4±5.7)h,P=0.000],术后舒芬太尼的用量显著少于对照组[(30.3±4.4)μg比(37.3±10.1)μg,P=0.001]。术毕时DEX组的MAP略低于对照组,但差异无统计学意义[(87.3±8.6)mmHg比(91.5±9.0)mmHg,P=0.063,1 mmHg=0.133 kPa],其余时间点两组间的MAP和HR无明显差异。诱导前、术毕即刻、术后24 h,两组LPS差异无统计学意义,但均高于正常水平(<54.2 EU/ml);术后48 h,DEX组的LPS和CRP低于对照组,但差异无统计学意义[(79.7±44.5)EU/ml比(105.4±59.6)EU/ml,P=0.055;(14128.2±2050.5)mg/L比(14912.4±1448.5)mg/L,P=0.082];术后72 h,DEX组的LPS和CRP显著低于对照组[(70.4±32.2)EU/ml比(104.3±53.6)EU/ml,P=0.003;(13960.3±1570.3)mg/L比(15155.2±1403.3)mg/L,P=0.002]。各时间点TNF-α水平组间比较差异无统计学意义(P>0.05)。结论小剂量DEX可以缩短行腰椎融合术的老年患者术后首次排气时间,机制可能包括通过药物本身的剂量相关作用、阿片类药物的节省效应和减轻炎性反应作用。Objective To investigate the impacts of low-dose dexmedetomidine(DEX)on postoperative gastrointestinal recovery in elderly patients undergoing lumbar spinal fusion.Methods Sixty-four patients undergoing elective lumbar spinal fusion were recruited.Those patients were randomized into the control group(n=32)and DEX group(n=32).In DEX group,DEX was administered to patients with a loading dose(0.5μg/kg)for 15 min and a maintenance rate of 0.1μg/(kg·h)till 30 min before skin closing.The control group received saline instead of DEX.Demographic,hemodynamic and surgical data were recorded.Postoperative overall sulfentanyl consumption of narcotics and duration to first flatus were recorded during follow-up.Lipopolysaccharides(LPS),TNF-αand CRP were tested at baseline before induction,the end of surgery,24,48,72 h after operation.Results The first postoperative bowel exhaust time in DEX group was shorter than that in the control group[(15.9±5.1)h vs.(21.4±5.7)h,P=0.000].Postoperative overall sulfentanyl consumption in the DEX group was less than that in the control group[(30.3±4.4)μg vs.(37.3±10.1)μg,P=0.001].At the end of surgery,mean arterial pressure(MAP)in DEX group seemed to be lower than that in the control group[(87.3±8.6)mmHg vs.(91.5±9.0)mmHg,P=0.063].There were no significant differences in MAP or heart rate(HR)at the any other timepoints.Before anesthesia induction,at the end of the operation,24 h after operation,LPS were similar and higher than the normal limit(<54.2 EU/ml)in both groups.Compared with the control group,there were lowering trend of LPS[(79.7±44.5)EU/ml vs.(105.4±59.6)EU/ml,P=0.055]and CRP[(14128.2±2050.5)mg/L vs.(14912.4±1448.5)mg/L,P=0.082]in DEX group at 48 h after operation.LPS[(70.4±32.2)EU/ml vs.(104.3±53.6)EU/ml,P=0.003]and CRP[(13960.3±1570.3)mg/L vs.(15155.2±1403.3)mg/L,P=0.002]in DEX group were significantly lower than those in the control group at 72 h after operation.There were no significant differences in TNF-αat any timepoints(P>0.05)between the two groups.Conc

关 键 词：右美托咪定 脊柱融合术 肠道功能 炎性介质 

分 类 号：R614[医药卫生—麻醉学]