右美托咪定合不同剂量咪达唑仑对非小细胞肺癌手术患者血流动力学和炎症介质、认知功能的影响  

Effects of Dexmedetomidine Combined with Different Doses of Midazolam on Hemodynamics,Inflammatory Mediators and Cognitive Function in Patients with Non-Small Cell Lung Cancer

作　　者：李璐[1] 王宁[1] 李禾南 李彬 杨旭明 LI Lu;WANG Ning;LI He-nan;LI Bin;YANG Xu-ming(Department of Anesthesia and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,450052,China;Department of Anesthesiology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan,450052,China;Operation Department of Anesthesia and Perioperative Medicine,The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan,473007,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,河南郑州450052 [2]河南科技大学第一附属医院麻醉科,河南洛阳471000 [3]南阳医学高等专科学校第一附属医院麻醉与围术期医学科手术部,河南南阳473007

出　　处：《现代生物医学进展》2022年第13期2596-2600,共5页Progress in Modern Biomedicine

基　　金：河南省医学科技攻关项目(201503037)。

摘　　要：目的:探讨右美托咪定联合不同剂量咪达唑仑对非小细胞肺癌(NSCLC)手术患者血流动力学和术后炎症介质、认知功能的影响。方法:纳入2019年1月-2021年2月期间来郑州大学第一附属医院接受手术治疗的NSCLC患者(n=120),按照麻醉方案的不同分为低剂量组(n=60)和高剂量组(n=60),两组均予以右美托咪定,在此基础上,低剂量组予以0.05 mg/kg咪达唑仑,高剂量组予以0.10 mg/kg咪达唑仑。对比两组患者的血流动力学、炎症介质、认知功能、苏醒质量和不良反应发生率。结果:两组麻醉诱导后10 min(T1)~拔管后5 min(T3)时间点心率(HR)、平均动脉压(MAP)升高后下降,且拔管即刻(T2)、T3时间点高剂量组低于低剂量组(P<0.05)。高剂量组的苏醒后疼痛视觉模拟评分(VAS)评分低于低剂量组,睁眼时间、拔管时间、麻醉恢复室(PACU)停留时间均短于低剂量组(P<0.05)。两组术前、术后3 d、术后7 d白介素-1(IL-1)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)升高后下降,且术后3 d、术后7 d高剂量组低于低剂量组(P<0.05)。两组术后1 d、术后3 d、术后7 d简易精神状态量表(MMSE)评分组间对比未见统计学差异(P>0.05)。两组不良反应发生率组间对比无统计学差异(P>0.05)。结论:与0.05 mg/kg咪达唑仑相比,右美托咪联合0.10 mg/kg咪达唑仑定用于NSCLC手术患者,维持血流动力学稳定、提高苏醒质量、减轻炎症应激的效果更为显著,且不增加认知功能损害和不良反应发生率。Objective:To investigate the effects of dexmedetomidine combined with different doses of midazolam on hemodynamics,postoperative inflammatory mediators and cognitive function in patients with non-small cell lung cancer(NSCLC).Methods:Patients with NSCLC(n=120) who came to The First Affiliated Hospital of Zhengzhou University for surgical treatment from January 2019 to February 2021 were included,they were divided into low-dose group(n=60) and high-dose group(n=60) according to different anesthesia schemes.Both groups were given dexmedetomidine,on this basis,the low-dose group was given 0.05 mg/kg midazolam,and the high-dose group was given 0.10 mg/kg midazolam.Hemodynamics,inflammatory mediators,cognitive function,awakening quality and incidence of adverse reactions were compared between the two groups.Results:The heart rate(HR) and mean arterial pressure(MAP) increased and then decreased in two groups from 10 min after anesthesia induction(T1) to 5min after extubation(T3)time points,and immediately after extubation(T2) and T3 time points,the high-dose group was lower than the low-dose group(P0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Compared with 0.05 mg/kg midazolam,dexmedetomide combined with 0.10 mg/kg midazolam has a more significant effect on maintaining hemodynamic stability,improving the quality of recovery and alleviating inflammatory stress in patients undergoing NSCLC surgery,without increasing the cognitive impairment and incidence of adverse reactions.

关 键 词：右美托咪定 不同剂量 咪达唑仑 非小细胞肺癌 血流动力学 炎症介质 认知功能 

分 类 号：R734.2[医药卫生—肿瘤]