不同剂量右美托咪定对老年肠道肿瘤患者术后谵妄的影响  

The effect of different doses of dexmedetomidine on postoperative delirium in elderly patients with intestinal tumors

作　　者：刘丹[1] 周鸿丽 付颖[1] 黄菲[1] LIU Dan;ZHOU Hong-li;FU Ying;HUANG Fei(Department of Anesthesiology,Meishan People's Hospital,Meishan 620000,China)

机构地区：[1]四川省眉山市人民医院麻醉科,四川眉山620000

出　　处：《实用医院临床杂志》2022年第5期58-62,共5页Practical Journal of Clinical Medicine

摘　　要：目的 观察术中泵注不同剂量右美托咪定对老年肠道肿瘤手术患者术后谵妄、术中循环以及术后镇痛的影响。方法 择期行腹腔镜下老年肠道肿瘤手术患者120例,按随机数字表法分为D1组、D2组、D3组和空白组(C组)各30例。D1~D3组麻醉诱导前15 min均静脉泵注0.5μg/kg右美托咪定的负荷剂量,术中分别泵注0.2、0.4、0.6μg/(kg·h)右美托咪定,C组泵注生理盐水。比较四组插管前、插管后5 min、拔管后5 min的心率以及平均动脉压;谵妄发生情况、阿森斯失眠量表(AIS)、术后疼痛VAS评分,以及不良反应发生情况。结果 D2和D3组术后谵妄发生率低于C组(P<0.05)。术后第1天D1~D3组VAS评分低于C组(P<0.05),D3组AIS评分低于C组;术后第2天D2和D3组VAS评分低于C组,术后第3天D3组VAS评分低于C组(P<0.05)。D3组术中心动过缓发生例数、升压药的使用次数高于C组,术后镇痛药追加次数少于C组(P<0.05)。结论 术中泵注0.4、0.6μg/(kg·h)右美托咪定均可降低老年肠道肿瘤手术患者术后谵妄发生率并减轻术后早期疼痛,0.4μg/(kg·h)的右美托咪定不影响血流动力学的稳定。Objective To observe the effect of injected different doses of dexmedetomidine on postoperative delirium, intraoperative circulation and postoperative analgesia in elderly patients undergoing intestinal tumor surgery.Methods One hundred and twenty elderly patients undergoing elective laparoscopic intestinal tumor surgery were divided into a blank group(group C) and different dose groups(group D1, D2 and D3) according to random number table method, 30 in each group. The D1-D3 groups were intravenously pumped with a loading dose of 0.5μg/kg dexmedetomidine 15 minutes before induction of anesthesia, and 0.2, 0.4, 0.6 μg/(kg·h) dexmedetomidine were intraoperatively pumped, respectively. The group C was pumped with normal saline. Heart rate(HR) and mean arterial pressure(MAP) before intubation, 5 min after intubation and 5 min after extubation were recorded. Delirium, Athens Insomnia Scale(AIS), postoperative pain VAS score, and adverse reactions were compared among the four groups.Results The incidence of postoperative delirium in the D2 and D3 groups was significantly lower than that in the C group(P<0.05). Compared with the group C, the VAS score of the D1~D3 groups and the AIS score of the D3 group were decreased on the first postoperative day, the VAS score of the D2 and D3 groups was decreased on the second postoperative day, and the VAS score of the D3 group was decreased on the third postoperative day(all P<0.05). Compared with the group C, the incidence of intraoperative bradycardia and the frequency of use of antihypertensive drugs were increased in the group D3, but the frequency of use of postoperative analgesics was decreased(P<0.05).Conclusion Both 0.4 μg/(kg·h) and 0.6 μg/(kg·h) dexmedetomidine pumped intraoperatively for elderly patients undergoing intestinal tumor surgery can reduce the occurrence of postoperative delirium and relieve the early postoperative pain. 0.4μg/(kg·h) dexmedetomidine does not affect hemodynamic stability.

关 键 词：右美托咪啶 术后谵妄 老年患者 

分 类 号：R614[医药卫生—麻醉学]