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右美托咪定可减少老年患者长时间开腹术后谵妄的发生率：一项随机对照研究
Dexmedetomidine decreases postoperative delirium in the elderly undergoing long-term hepatopancreatobiliary surgery: a randomized controlled trail
- 第三军医大学学报 2021年43卷第4期 页码：318-323
- 作者机构：
1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
2.400020 重庆，958医院麻醉科
- 作者简介：
[ 顾健腾，E-mail:gjt1976@163.com GU Jianteng, E-mail:gjt1976@163.com
- 基金信息：
DOI：10.16016/j.1000-5404.202009131
中图分类号： R322.81;R329.28;R743.31收稿：2020-09-16，
修回：2020-11-03，
纸质出版：2021-04-15
- 稿件说明：
移动端阅览
陈星同, 秦志刚, 陈妍, 等. 右美托咪定可减少老年患者长时间开腹术后谵妄的发生率：一项随机对照研究[J]. 第三军医大学学报, 2021,43(4):318-323.
Xingtong CHEN, Zhigang QIN, Yan CHEN, et al. Dexmedetomidine decreases postoperative delirium in the elderly undergoing long-term hepatopancreatobiliary surgery: a randomized controlled trail[J]. Journal of Third Military Medical University, 2021, 43(4): 318-323.
陈星同, 秦志刚, 陈妍, 等. 右美托咪定可减少老年患者长时间开腹术后谵妄的发生率：一项随机对照研究[J]. 第三军医大学学报, 2021,43(4):318-323. DOI： 10.16016/j.1000-5404.202009131.
Xingtong CHEN, Zhigang QIN, Yan CHEN, et al. Dexmedetomidine decreases postoperative delirium in the elderly undergoing long-term hepatopancreatobiliary surgery: a randomized controlled trail[J]. Journal of Third Military Medical University, 2021, 43(4): 318-323. DOI： 10.16016/j.1000-5404.202009131.
摘要
目的
2
观察术中使用右美托咪定(dexmedetomidine
Dex)对接受长时全麻肝胆胰开腹手术老年患者术后谵妄的影响。
方法
2
按标准纳入手术时长超4 h的肝胆胰开腹手术老年患者50例，按随机数字表法将其分为对照组(按估算右美托咪定泵注速度进行生理盐水持续泵注，
n
=25)和试验组(麻醉诱导后，按1 μg/kg负荷剂量泵注右美托咪定10 min，之后改为0.5 μg·kg
-1
·h
-1
维持，
n
=25)。分别于麻醉诱导时(T
0
)、手术结束时(T
1
)、拔管后5 min(T
2
)、拔管后30 min(T
3
)记录患者的平均动脉压(mean arterial pressure，MAP)和心率(heart rate，HR)，于T
2
和T
3
对患者进行疼痛视觉模拟评分(visual analogue score，VAS)和镇静躁动评分(riker sedation-agitation scale，RSAS)，并记录入恢复室(postanesthesia care unit
PACU)后拔管时间、PACU停留时间、术后恶心呕吐(postoperative nausea and vomiting
PONV)发生情况、苏醒期谵妄发生情况以及出PACU的Aldrete评分情况。于手术切皮前(T
a
)和术后1 h(T
b
)采血ILISA检测IL-6。术后第1天随访并完成简易智能精神状态(Mini-Mental State Examination，MMSE)评分，术后1~3 d完成意识错乱评估(confusion assessment method
CAM)进行术后持续性谵妄(postoperative delirium
POD)筛查，随后通过查阅电子病例系统及电话随访追踪患者神经功能情况。
结果
2
试验组在T
2
和T
3
的RSAS评分低于对照组(
P
<
0.05)；试验组在T
3
的VAS评分低于对照组(
P
<
0.05)。与T
a
相比，T
b
时两组患者IL-6均升高(
P
<
0.05)；T
b
时试验组IL-6水平低于对照组(
P
<
0.05)；对照组出现苏醒期谵妄的患者人数为试验组的3倍；对照组术后第1天出现认知功能障碍的人数是试验组的2倍；两组患者均未观察到存在术后持续性谵妄。
结论
2
对于长时全麻肝胆胰开腹手术老年患者，术中使用右美托咪定可减少术后苏醒期谵妄的发生、改善术后神经功能；其潜在机制可能与右美托咪定的抗炎作用相关。
Abstract
Objective
2
To determine the effect of dexmedetomidine (Dex) on the postoperative delirium (POD) in elderly patients undergoing long-term hepatopancreatobiliary surgery with general anesthesia.
Methods
2
A total of 50 elderly patients who underwent scheduled hepatopancreatobiliary surgery over 4 h were enrolled in this study
and randomly divided into a control group (
n
=25) and a Dex group (
n
=25). After induction of anesthesia
a loading dose of Dex at 1 μg/kg was infused for 10 min and then changed to 0.5 μg/(kg·h) for maintenance in the Dex group. The same volume of normal saline was infused in the control group. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the induction of anesthesia (T
0
)
the end of the operation (T
1
)
5 min after extubation (T
2
)
and 30 min after extubation (T
3
). Visual analogue score (VAS) and Riker sedation-agitation scale (RSAS) were performed on the patients at T
2
and T
3
. Other data were collected as follows: the extubation time
postanesthesia care unit (PACU) stay time
incidence of emergence delirium
incidence of postoperative nausea and vomiting (PONV)
and Aldrete score before leaving the PACU. Blood samples were collected for IL-6 measurements before surgery (T
a
) and at 1 h after surgery (T
b
). Mini-Mental state examination (MMSE) was completed on the first day after operation
and POD was assessed by the Confusion Assessment Method (CAM) on the first 3 d after operation. The neurological function of the patients was followed up by the electronic medical system and telephone.
Results
2
The RSAS scores in the Dex group were lower than those in the control group at T
2
and T
3
(
P
<
0.05). The VAS score in the Dex group at T
3
was lower than that of the control group (
P
<
0.05). Compared with T
a
the
IL-6 level in both 2 groups were significantly higher at T
b
(
P
<
0.05). At T
b
the level in the Dex group was lower than that in the control group (
P
<
0.05). Compared with the Dex group
the number of patients with emergence delirium or with cognitive dysfunction on the first day after the operation was 3 times and twice
respectively
as in the control group. In both groups
there were no patients with postoperative delirium persists or reoccurrence after initial emergence from anesthesia.
Conclusion
2
The intraoperative use of Dex may reduce the emergence delirium after general anesthesia and improve the postoperative neurological function in elderly patients undergoing long-term hepatopancreatobiliary surgery. The mechanism may be associated with the anti-inflammatory effects of Dex.
关键词
Keywords
references
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