全身麻醉复合右美托咪定对腹腔镜子宫全切术患者围术期应激反应和术后认知功能影响  

Effects of general anesthesia combined with dexmedetomidine during laparoscopic total hysterectomy of patients on their perioperative stress response and postoperative cognitive function

作　　者：于浏 李桂华 张望平[1] YU Liu;LI Guihua;ZHANG Wangping(Jiaxing Maternity and Child Health Care Hospital,Jiaxing,Zhejing Province,314001)

机构地区：[1]浙江省嘉兴市妇幼保健院,314001

出　　处：《中国计划生育学杂志》2022年第5期1060-1064,共5页Chinese Journal of Family Planning

摘　　要：目的:分析全身麻醉复合右美托咪定对腹腔镜子宫全切术患者围术期应激反应和术后认知功能的影响.方法:选取本院2019年3月—2021年3月择期行腹腔镜子宫全切术的患者140例,随机数字表法分为观察组和对照组各70例,对照组采用常规全身麻醉,观察组采用右美托咪定复合全身麻醉.比较两组麻醉前(T0)、术中(T1)和术后1h(T2)时血清皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、内皮素(ET)、超氧化物歧化酶(SOD)、丙二醛(MDA)等应激反应指标;采用警觉-镇静量表(OAAS)和简易智力状态检查量表(MMSE)评估患者术后意识和认知功能,统计不良反应情况.结果:T1、T2时两组血清Cor、AngⅡ、ET、MDA水平均较T0时降低,SOD水平较T0时升高,T1、T2时观察组血清Cor、AngⅡ、ET、MDA水平均低于对照组,SOD水平高于对照组(均P<0.05);术毕、拔管时及术后1h的OAAS评分两组均依次升高且观察组高于对照组,两组术后1h、4h、12hMMSE评分均依次升高且观察组高于对照组(均P<0.05).观察组POCD发生率(2.9%)低于对照组(14.3%)(P<0.05),不良反应发生率观察组(5.7%)与对照组(8.6%)无差异(P>0.05).结论:右美托咪定复合全身麻醉可有效减轻腹腔镜子宫全切术患者应激反应,利于患者术后意识和认知功能的恢复,且安全性较高.Objective: To analyze the effects of general anesthesia combined with dexmedetomidine during laparoscopic total hysterectomy of patients on their perioperative stress response and postoperative cognitive function. Methods: A total of 140 patients who wanted elective laparoscopic hysterectomy were selected and were randomly divided into two groups(70 cases in each group) according to the random number table from March 2019 to March 2021. The patients in the control group were treated with routine general anesthesia during operation, while the patients in the observation group were treated with dexmedetomidine combined with general anesthesia during operation. The levels of serum stress response indexes, such as cortisol(Cor), angiotensin II(AngⅡ), endothelin(ET), superoxide dismutase(SOD), and malondialdehyde(MDA) of the patients before anesthesia(T0), during operation(T1), and postoperative 1 h(T2) were compared between the two groups. Postoperative consciousness and cognitive function of the patients were assessed by observer assessment of sedation(OAAS) and mini-mental state examination(MMSE). The rate of adverse reactions of the patients in two groups were counted. Results: The levels of serum Cor, Ang Ⅱ, ET, and MDA of the patients in the two groups at T1 and T2 were significantly lower than those of the patients at T0, and the level of SOD of the patients in the two groups at T1 or T2 was significantly higher than that at T0. The levels of serum Cor, Ang Ⅱ, ET, and MDA of the patients in the observation group at T1 and T2 were significantly lower than those of the patients in the control group, and the level of SOD of the patients in the observation group at T1 or T2 was significantly higher than that of the patients in the control group(all P<0.05).The OAAS scores of the patients in the two groups at the end of operation,at the time of extubation,and at T2had increased gradually,and which of the patients in the observation group were significantly higher than those of the patients in the control group

关 键 词：腹腔镜子宫全切术 全身麻醉 右美托咪定 围术期应激反应 认知功能 

分 类 号：R614[医药卫生—麻醉学]