不同剂量右美托咪定在甲状腺癌手术患者中的应用效果及脑保护效应分析  

Analysis of the application effect and cerebral protective effect of different doses of dexmedetomidine on patients with thyroid cancer undergoing surgery

作　　者：曾正鹏 杨鑫 常遇春 张恩茂 夏维波 ZENG Zhengpeng;YANG Xin;CHANG Yuchun;ZHANG Enmao;XIAWeibo(Department of Anesthesiology,the First People’s Hospital of Zhaotong,Zhaotong 657000,Yunnan,China;Department of General Surgery,the First People’s Hospital of Zhaotong,Zhaotong 657000,Yunnan,China)

机构地区：[1]昭通市第一人民医院麻醉科,云南昭通657000 [2]昭通市第一人民医院普外科,云南昭通657000

出　　处：《癌症进展》2024年第1期79-83,共5页Oncology Progress

摘　　要：目的分析不同剂量右美托咪定在甲状腺癌手术患者中的应用效果及脑保护效应。方法选取300例甲状腺癌患者,按照不同右美托咪定剂量分为高剂量组、低剂量组以及对照组,每组100例。所有患者全身静脉麻醉后行甲状腺癌根治术,高、低剂量组在麻醉诱导后经静脉给予1.0μg/kg、0.5μg/kg盐酸右美托咪定注射液10 ml,对照组给予0.9%氯化钠注射液10 ml。比较3组患者的血流动力学指标[平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))、心率(HR)]、麻醉相关指标、止痛镇静效果、脑保护效应指标[神经元特异性烯醇化酶(NSE)、胶质细胞原纤维酸性蛋白(GFAP)、中枢神经特异蛋白β(S100β)]及不良反应发生情况。结果麻醉前(T_(0))、麻醉诱导时(T_(1))、手术开始15 min时(T_(2))、病灶切除时(T_(3))、手术缝合时(T_(4)),高剂量组与低剂量组患者的MAP、HR均明显低于对照组,SpO_(2)均明显高于对照组,差异均有统计学意义(P﹤0.01)。高剂量组与低剂量组患者的苏醒时间、意识恢复时间、气管拔管时间、恢复室停留时间均明显短于对照组,差异均有统计学意义(P﹤0.01)。术后1、2、4、12 h,高剂量组与低剂量组患者的视觉模拟评分法(VAS)评分均明显低于对照组,Ramsay评分均明显高于对照组,差异均有统计学意义(P﹤0.01)。术后24 h,高剂量组与低剂量组患者的NSE、GFAP、S100β水平均明显低于对照组,差异均有统计学意义(P﹤0.01)。高剂量组患者不良反应总发生率明显高于低剂量组和对照组,差异均有统计学意义(P﹤0.01)。结论右美托咪定对甲状腺癌手术患者具有良好的应用效果,能够改善患者手术期间的血流动力学指标,促进患者术后快速苏醒,具有良好的止痛镇静效果和脑保护作用,且小剂量的右美托咪定安全性更好,可在临床推荐使用。Objective To analyze the application effect and cerebral protective effect of different doses of dexmedetomidine on patients with thyroid cancer undergoing surgery.Method A total of 300 patients with thyroid cancer were selected and divided into high dose group,low dose group and control group according to different doses of dexmedetomidine,with 100 cases in each group.All patients were received radical thyroidectomy after intravenous general anesthesia.After induction of anesthesia,high and low dose groups were received 10 ml 1.0μg/kg and 0.5μg/kg dexmedetomidine injection intravenously,and control group was received 10 ml 0.9%sodium chloride injection.The hemodynamic indexes[mean arterial pressure(MAP),pulse blood oxygen saturation(SpO_(2)),heart rate(HR)],anesthesia-related indexes,analgesic effect,cerebral protective effect indexes[neuron specific enolase(NSE),glial fibrillary acidic protein(GFAP),soluble protein 100β(S100β)]and adverse reactions were compared among the three groups.Result Before anesthesia(T_(0)),during anesthesia induction(T_(1)),during 15 minutes after surgery(T_(2)),during lesion resection(T_(3)),during surgical suturing(T4),MAP and HR in high and low dose groups were significantly lower than those in control group,and SpO_(2)were significantly higher than those in control group,and the differences were statistically significant(P<0.01).The awakening time,consciousness recovery time,tracheal extubation time and recovery room stay time in high and low dose groups were significantly shorter than those in control group,and the differences were statistically significant(P<0.01).At 1,2,4,12 h after surgery,visual analogue scale(VAS)scores in high and low dose groups were significantly lower than those in control group,and Ramsay scores were significantly higher than those in control group,and the differences were statistically significant(P<0.01).At 24 h after surgery,NSE,GFAP and S100βlevels in high and low dose groups were significantly lower than those in control group,and the differen

关 键 词：甲状腺癌 右美托咪定 不同剂量 脑保护效应 

分 类 号：R736.1[医药卫生—肿瘤]