右美托咪定联合综合体温保护对围术期老年恶性肿瘤患者的影响  

Effects of dexmedetomidine combined with comprehensive body temperature protection foRperioperative elderly patients with malignancies

作　　者：胡建 许建峰 邢凡 章壮云 卞清明[2] 顾连兵[2] HU Jian;XU Jianfeng;XING Fan;ZHANG Zhuangyun;BIAN Qingming;GU Lianbing(Department of Anesthesiology,Lishui District People′s Hospital in Nanjing of Jiangsu Province,Lishui Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu,211200;Department of Anesthesiology,Jiangsu Provincial CanceRHospital,Jiangsu Institute of CanceRPrevention and Treatment/CanceRHospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu,210009)

机构地区：[1]江苏省南京市溧水区人民医院/东南大学附属中大医院溧水分院麻醉科,江苏南京211200 [2]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院麻醉科,江苏南京210009

出　　处：《实用临床医药杂志》2022年第3期105-108,112,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省第五期333高层次人才项目(2018Ⅲ-0169);江苏省南京市十三五第一层次青年卫生人才项目(QRX17034);江苏大学临床医学科技发展基金项目(JLY20180214)。

摘　　要：目的探讨右美托咪定联合综合体温保护对老年恶性肿瘤患者术后谵妄及血清S100钙结合蛋白β(S100β)、神经元特异性烯醇化酶(NSE)水平的影响。方法选择90例择期行外科手术治疗的恶性肿瘤患者,随机分为对照组(C组)、体温保护组(T组)、体温保护联合右美托咪定组(T-D组),每组30例。C组采用常规体温保护,T组和T-D组采用综合体温保护。T-D组泵注0.5μg/kg右美托咪定,10 min后麻醉诱导。观察并记录3组患者麻醉诱导即刻(T_(0))和手术开始0.5 h(T_(1))、1 h(T_(2))、1.5 h(T_(3))、2 h(T_(4))以及术毕(T_(5))鼻咽温度;记录3组患者苏醒期躁动、寒颤及术后谵妄的发生率;检测各组患者麻醉诱导前10 min、术后24 h、术后72 h血清S100β、NSE水平。结果与T_(0)比较,C组T_(1)至T_(5)5个时点的鼻咽温度降低,差异有统计学意义(P<0.05);T组、T-D组T_(2)至T_(5)4个时点的鼻咽温度高于C组,差异有统计学意义(P<0.05)。T组、T-D组患者苏醒期躁动、术后谵妄及寒颤的发生率均低于C组,差异有统计学意义(P<0.05);与T组比较,T-D组苏醒期躁动、术后寒颤的发生率更低,差异有统计学意义(P<0.05)。T-D组患者术后24 h、术后72 h血清S100β、NSE水平均低于C组和T组,差异有统计学意义(P<0.05)。结论右美托咪定联合综合体温保护能够显著降低患者血清S100β、NSE水平,并有效降低患者术后谵妄、苏醒期躁动及寒颤的发生率。Objective To explore the effect of dexmedetomidine combined with comprehensive body temperature protection on postoperative delirium and the levels of serum S100 beta(S100β),neuron specific enolase(NSE)in elderly patients with malignancies.Methods A total of 90 elderly patients undergoing elective malignant tumoRsurgery were randomly divided into three groups:control group(group C,n=30),temperature protection group(group T,n=30)and temperature protection combined with dexmedetomidine group(group T-D,n=30).Routine thermal insulation in operation was adopted in the group C,while the group T and group T-D adopt comprehensive body temperature protection measures.In group T-D,dexmedetomidine was given at a dosage of 0.5μg/kg 10 min before anesthesia induction.The nasopharyngeal temperature was recorded at induction of anesthesia(T_(0)),0.5 h afte operation(T_(1)),1 h afte operation(T_(2)),1.5 h afte operation(T_(3)),2 h afte operation(T_(4)) and completion of operation(T_(5)).The incidence of emergence agitation,chills and postoperative delirium were recorded.Serum S100β,NSE levels in three groups were measured at 10 min before induction of anesthesia,24 h and 72 h afte operation.Results Compared with T_(0),the nasopharyngeal temperatures in the group C at T_(1) to T_(5) time points were significantly decreased(P<0.05),and were obviously highe in the group T and group T-D at T_(2) to T_(5) time points than those in the group C(P<0.05).The incidence rates of emergence agitation,postoperative delirium and chills in the group T,group T-D were significantly lowe than those in the group C(P<0.05).Compared with the group T,the incidence rates of emergence agitation and postoperative chills were furthe decreased(P<0.05).Compared with the group C and group T,serum S100βand NSE levels in the group T-D at 24 h and 72 h afte operation were significantly decreased(P<0.05).Conclusion The combination of dexmedetomidine and comprehensive body temperature protection can obviously decrease the levels of serum S100βand NSE,and eff

关 键 词：右美托咪定 体温保护 恶性肿瘤 S100钙结合蛋白β 神经元特异性烯醇化酶 

分 类 号：R735.3[医药卫生—肿瘤] R614[医药卫生—临床医学]