不同剂量右美托咪定联合盐酸艾司氯胺酮对机器人辅助腹腔镜下根治性前列腺切除术患者的影响  

Effect of different doses of dexmedetomidine combined with esketamine hydrochloride in patients undergoing robot-assisted laparoscopic radical prostatectomy

作　　者：宿明艳[1] 刘晓杰[1] 崔士和[1] 周瑜[1] SU Mingyan;LIU Xiaojie;CUI Shihe;ZHOU Yu(Department of Anesthesiology,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210000,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210000

出　　处：《机器人外科学杂志(中英文)》2025年第2期245-250,共6页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金青年科学基金项目(H0903)。

摘　　要：目的:探讨不同剂量右美托咪定联合盐酸艾司氯胺酮对机器人辅助腹腔镜下根治性前列腺切除术(RARP)患者的应用效果及对其血流动力学、认知功能、谵妄和不良反应发生率的影响。方法:前瞻性选取南京大学医学院附属鼓楼医院于2021年1月-2024年1月收治的80例RARP患者,分为3组,A组、B组各25例,C组30例。A组给予0.2 mg/kg盐酸艾司氯胺酮+生理盐水,B组给予0.2 mg/kg盐酸艾司氯胺酮+0.5μg/(kg·h)右美托咪定,C组给予0.2 mg/kg盐酸艾司氯胺酮+0.7μg/(kg·h)右美托咪定。对比三组患者血流动力学指标、Ramesay镇静评分、疼痛视觉模拟评分法(VAS)评分、苏醒质量、蒙特利尔认知评估量表(MoCA)评分、谵妄及不良反应发生率。结果:气管插管即刻和手术开始时,三组患者血氧饱和度均降低,B、C两组血氧饱和度高于A组(P<0.05),三组患者心率、平均动脉压均升高,B、C两组心率、平均动脉压低于A组(P<0.05);B组与C组患者各时点血流动力学指标比较,差异均无统计学意义(P>0.05)。三组患者手术结束清醒后、术后2 h、术后6 h Ramesay镇静评分比较,差异无统计学意义(P>0.05),术后2 h、术后6 h B、C两组VAS评分均低于A组(P<0.05),B组与C组差异无统计学意义(P>0.05)。B组拔除气管插管时间、呼叫自睁眼时间短于A组和C组(P<0.05),B组和C组自主呼吸恢复时间短于A组,且术中丙泊酚用量、舒芬太尼用量少于A组(P<0.05)。术后1 d B、C两组MoCA评分高于A组(P<0.05),B组与C组比较差异无统计学意义(P>0.05)。B组和C组谵妄发生率低于A组(P<0.05),B组不良反应总发生率低于A组和C组(P<0.05)。结论:右美托咪定联合盐酸艾司氯胺酮在RARP患者中的应用效果显著,可减轻患者术后血流动力学指标波动,提升术后镇痛效果和苏醒质量,减少术中丙泊酚、舒芬太尼用量,改善术后认知功能水平,降低谵妄发生率,且应用0.5μg/(kg·h)剂量的右美托咪定效�Objective:To investigate the effect of different doses of dexmedetomidine combined with esketamine hydrochloride in patients undergoing robot-assisted laparoscopic radical prostatectomy(RARP)and its influence on hemodynamics,cognitive function,delirium,and the incidence of adverse reactions.Methods:80 patients who underwent RARP from January 2021 to January 2024 in Drum Tower Hospital Affiliated to Nanjing University Medical School were prospectively selected and divided into three groups:25 patients in the group A and group B,30 patients in group C.Group A was given 0.2 mg/kg esketamine hydrochloride+physiological saline,group B was given 0.2 mg/kg esketamine hydrochloride+0.5μg/(kg·h)dexmedetomidine,and group C was given 0.2 mg/kg esketamine hydrochloride+0.7μg/(kg·h)dexmedetomidine.Hemodynamic indexes,Ramesay sedation score,visual analog scale(VAS)score,quality of awakening,Montreal cognitive assessment(MoCA)score,delirium,and incidence of adverse reactions were compared among the three groups.Results:At the moment of endotracheal intubation and the beginning of surgery,the oxygen saturation decreased in the three groups of patients,and it was higher in group B and group C than group A(P<0.05).Heart rate and mean arterial pressure increased in the three groups of patients,and they were lower in group B and group C than group A(P<0.05).The comparison of hemodynamic indexes of patients between group B and group C at each point in time showed no statistically significant difference(P>0.05).The differences in Ramesay sedation scores at postoperative wakefulness,2 h and 6 h after surgery among the three groups of patients were not statistically significant(P>0.05).VAS scores at 2 h and 6 h after surgery in group B and group C were lower than group A(P<0.05),and the differences between group B and group C were not statistically significant(P>0.05).The time for removing tracheal intubation and calling for the time of self-opening of eyes were shorter in group B than those in group A and group C(P<0.05),the recove

关 键 词：右美托咪定 盐酸艾司氯胺酮 机器人辅助手术 根治性前列腺切除术 

分 类 号：R614[医药卫生—麻醉学]