布托啡诺联合不同剂量右美托咪定对行经腹膜外入路单孔腹腔镜前列腺癌根治术前列腺癌患者影响  

Effect of butorphanol combined with different doses of dexmedetomidine on analgesia,cognitive function and inflammatory factors in patients with prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy

作　　者：顾美蓉[1] 钱怡玲 徐晶晶[1] 王依慰 张正正[1] 苗帅 周文婷 GU Mei-rong;QIAN Yi-ling;XU Jing-jing;WANG Yi-wei;ZHANG Zheng-zheng;MIAO Shuai;ZHOU Wen-ting(Department of Anes-thesiology,Wuxi People′s Hospital Affiliated to Nanjing Medical University,Wuxi 214000,China)

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,江苏无锡214000

出　　处：《临床军医杂志》2021年第9期994-998,共5页Clinical Journal of Medical Officers

基　　金：国家自然科学基金资助项目(82001474)。

摘　　要：目的探讨布托啡诺联合不同剂量右美托咪定对行经腹膜外入路单孔腹腔镜前列腺癌根治术(ELRP)的前列腺癌患者的影响。方法选取无锡市人民医院自2017年1月至2020年12月收治的85例行ELRP的前列腺癌患者为研究对象。将患者随机分入A组(n=28)、B组(n=28)及C组(n=29)。ELRP术后镇痛配方为:A组0.1 mg/kg酒石酸布托啡诺注射液;B组0.1 mg/kg酒石酸布托啡诺注射液+2.0μg/kg右美托咪定;C组0.1 mg/kg酒石酸布托啡诺注射液+4.0μg/kg右美托咪定。比较3组的围术期指标,术后1、12、24、48 h的视觉模拟评分法(VAS)评分,术前和术后1、3 d的简易智力状态检查量表(MMSE)评分和白细胞介素(IL)-6、肿瘤坏死因子α(TNF-α)水平,以及并发症发生率。结果3组手术时间、麻醉时间、苏醒时间、拔管时间、复苏室停留时间及术中出血量比较,差异均无统计学意义(P>0.05)。3组术后1 h VAS评分比较,差异无统计学意义(P>0.05);B组和C组术后12、24、48 h VAS评分均低于A组,差异有统计学意义(P<0.05);3组术后12、24、48 h VAS评分由高至低排序分别为术后24 h、术后12 h、术后48 h,各时间点VAS评分两两比较,差异均有统计学意义(P<0.05)。3组术前MMSE评分比较,差异无统计学意义(P>0.05);B组和C组术后1、3 d MMSE评分均高于A组,差异有统计学意义(P<0.05);3组术后3 d MMSE评分均低于术后1 d,差异有统计学意义(P<0.05)。3组术前IL-6和TNF-α水平比较,差异无统计学意义(P>0.05);B组和C组术后1、3 d IL-6和TNF-α水平均低于A组,差异有统计学意义(P<0.05);3组术后3 d IL-6和TNF-α水平均低于术后1 d,差异有统计学意义(P<0.05)。A组和B组皮肤瘙痒、恶心呕吐、口干、心动过缓、低血压发生率均低于C组,差异有统计学意义(P<0.05)。结论对行ELRP的前列腺癌患者采用布托啡诺联合右美托咪定术后镇痛可有效提升镇痛效果,改善认知功能,降低炎症因子表达水平,但4.0μg/kg右Objective To study the effect of butorphanol combined with different doses of dexmedetomidine on analgesia,cognitive function and inflammatory factors in patients with prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy(ELRP).Methods A total of 85 patients with prostate cancer treated in Wuxi People′s Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020 were randomly divided into three groups:group A(n=28),group B(n=28)and group C(n=29).All patients were treated with ELRP,the patients in group A were given only 0.1 mg/kg butorphanol,the patients in group B were treated with 0.1 mg/kg butorphanol and 2.0μg/kg dexmedetomidine,the patients in group C were treated with 0.1 mg/kg butorphanol and 4.0μg/kg dexmedetomidine.The surgical condition,pain level,cognitive function,inflammatory factors and adverse reactions among the three groups were compared and analyzed.Results There was no significant difference in operation time,anesthesia time,awakening time,extubation time,resuscitation room stay time and intraoperative blood loss among the three groups(P>0.05).There was no significant difference in visual analogue scale(VAS)score 1 hour after operation among the three groups(P>0.05).VAS scores of group B and group C were lower than group A at 12,24 and 48 hours after surgery,the difference was statistically significant(P<0.05).VAS scores of the three groups at 12,24 and 48 hours after surgery were ranked from high to low,respectively,24 hours,12 hours and 48 hours after surgery.Comparison of VAS scores at each time point showed statistical significance(P<0.05).There was no significant difference in preoperative mini-mental state examination(MMSE)score among the three groups(P>0.05).MMSE scores of group B and group C were higher than group A at 1 and 3 days after operation,the difference was statistically significant(P<0.05).On postoperative day 3,the MMSE scores of the 3 groups were lower than those of the 1 day after operation,the difference was statistically

关 键 词：布托啡诺 右美托咪定 经腹膜外入路单孔腹腔镜前列腺癌根治术 前列腺癌 镇痛 认知功能 炎症因子 

分 类 号：R737.25[医药卫生—肿瘤]