右美托咪定对老年患者腹腔镜宫颈癌根治术后谵妄的预防效果观察  

Observation on the Preventive Effect of Dexmedetomidine on Postoperative Delirium in Elderly Patients After Laparoscopic Radical Hysterectomy for Cervical Cancer

作　　者：张思捷 ZHANG Si-jie(Department of Anesthesia and Pain,Tianjin Taida Hospital,Tianjin 300457,China)

机构地区：[1]天津市泰达医院麻醉与疼痛科,天津300457

出　　处：《医学信息》2022年第15期87-90,共4页Journal of Medical Information

摘　　要：目的研究右美托咪定对老年患者腹腔镜宫颈癌根治术后谵妄(POD)的预防效果。方法选取2018年9月-2021年9月于我院行腹腔镜宫颈癌根治术治疗的98例老年患者为研究对象,采用随机数字表法分为对照组与观察组,各49例。两组均行全麻气管插管,观察组于麻醉诱导后静脉输注右美托咪定,对照组则给予等量生理盐水,比较两组术后疼痛视觉模拟评分(VAS)、Ramsay镇静评分、POD发生率、炎性因子水平[肿瘤坏死因子(TNF-α)、白介素1β(IL-1β)]、儿茶酚胺[去甲肾上腺素(NA)、肾上腺素(E)]、皮质醇(COR)、脑损伤指标[神经元特异性烯醇化酶(NSE)、S100β蛋白]及不良反应发生情况。结果观察组术后VAS评分低于对照组,Ramsay镇静评分高于对照组(P<0.05);观察组POD发生率为2.04%,低于对照组的14.29%(P<0.05);两组术后1 h TNF-α、IL-1β、NA、E、COR、NSE、S100β蛋白水平均高于麻醉诱导前,但观察组低于对照组(P<0.05);观察组不良反应发生率为8.16%,低于对照组的24.49%(P<0.05)。结论右美托咪定可提高老年患者的术后镇痛效果,降低术后谵妄风险,抑制中枢炎症反应,降低儿茶酚胺及皮质醇浓度,减轻脑损伤,且不良反应少。Objective To study the preventive effect of dexmedetomidine on postoperative delirium(POD)after laparoscopic radical hysterectomy for cervical cancer in elderly patients.Methods A total of 98 elderly patients who underwent laparoscopic radical cervical cancer treatment in our hospital from September 2018 to September 2021 were selected and randomly divided into a control group and an observation group,with 49 cases in each group.Both groups underwent general anesthesia tracheal intubation.The observation group received intravenous infusion of dexmedetomidine after induction of anesthesia,and the control group received the same amount of normal saline.The visual analogue scale(VAS),Ramsay sedation score,incidence of POD,levels of inflammatory factors[tumor necrosis factor(TNF-α),interleukin 1β(IL-1β)],catecholamine[norepinephrine(NA),epinephrine(E)],cortisol(COR),brain injury indexes[neuron-specific enolase(NSE),S100βprotein]and adverse reactions were compared between the two groups.Results The postoperative VAS score of the observation group was lower than that of the control group,and the Ramsay sedation score was higher than that of the control group(P<0.05).The incidence of POD in the observation group was 2.04%,which was lower than 14.29%in the control group(P<0.05).The protein levels of TNF-α,IL-1β,NA,E,COR,NSE and S100βat 1 h after operation in the two groups were higher than those before anesthesia induction,but the observation group was lower than the control group(P<0.05).The incidence of adverse reactions in the observation group was 8.16%,which was lower than 24.49%in the control group(P<0.05).Conclusion Dexmedetomidine can improve the postoperative analgesic effect of elderly patients,reduce the risk of postoperative delirium,inhibit central inflammatory response,reduce the concentration of catecholamine and cortisol,reduce brain injury,and has less adverse reactions.

关 键 词：腹腔镜宫颈癌根治术 右美托咪定 术后谵妄 中枢炎症反应 脑损伤 

分 类 号：R737.3[医药卫生—肿瘤]