右美托咪定对老年鼻内窥镜患者术后恢复和认知功能的影响
|
摘要
目的观察右美托咪定对全麻老年鼻内窥镜患者术后恢复和认知功能的影响。方法选择在全麻下行鼻内窥镜手术老年患者60例,回顾性分析患者的临床资料,根据药物给予方法将其分为右美托咪定组(D组)30例和对照组(C组)30例。D组麻醉诱导前给予右美托咪定0.5ug/kg,然后以0.2～0.5ug/kg/h静脉持续泵入,手术结束前30min停药。C组以相同方法给予同等剂量的0.9%生理盐水。记录麻醉诱导前(T0)、气管插管完成即刻(T1)、手术开始后1h(T2)、拔除气管导管即刻(T3),各个时间点的心率、平均动脉压。术后苏醒情况(自主呼吸恢复时间、睁眼时间、拔管时间),苏醒期的躁动情况,认知功能状况,不良反应情况。结果 C组患者T1、T3时血压、心率明显高于T0(P<0.05),D组患者T1、T3时血压、心率与T0比较无显著差异(P>0.05)。T1～T3时C组血压、心率均明显高于D组(P<0.05)。两组患者自主呼吸恢复时间、睁眼时间、拔管时间比较无显著差异(P>0.05)。C组患者躁动发生率和SAS评分都明显高于D组(P<0.05)。两组患者麻醉诱导前未使用药物时其MMSE评分比较无差异(P>0.05),两组患者术后4hMMSE评分较术前明显降低,C组患者降低程度较D组更明显。两组患者不良反应发生率比较(6.67%vs13.33%)差异间无统计学意义(P>0.05),且均无明显严重不良反应发生。结论麻醉诱导前15分钟给予右美托咪定0.5ug/kg,然后以0.2～0.5ug/kg/h静脉持续泵入,能有效减少鼻内窥镜手术老年患者血流动力学的波动,减轻病人术后躁动,不延长苏醒时间和拔管时间,不增加苏醒期并发症,可提高麻醉的安全性。
Objective To investigate influence of dexmedetomidine on postoperative awakening and cognitive function in elderly patients undergoing endoscopic sinus surgery.Methods 60 elderly patients of selective endoscopic sinus surgery were selected in hospital from April to November in 2016 and randomly divided into experiment group(D group)and control group(C group).In D group,the patients received intravenous injection of DEX(0.5ug/kg)before anesthesia induction,and then received continuous injection of DEX at a rate of 0.2-0.5ug/kg/h till 30 min before the operation finishing.In C group,physiological saline was used instead of DEX.Mean arterial blood pressure(MAP)and heart rate(HR)were determined before anesthesia(T0),during intubation(T1),1hour after operation(T2),during extubation(T3).The postoperative awaken time,agitation during awaken period,cognitive function and adverse reactions were observed.Results Changes of HR and MAP in D group had no obvious fluctuation.In C group,HR and MAP increased significantly at T1,T3.HR and MAP at T1,T2,T3 in D group were significantly lower than C group.Two groups of patients with spontaneous breathing recovery time,awake time and extubation time were no significant difference(P>0.05).The incidence of agitation and SAS scores were significantly higher in C group than those in D group(P<0.05).Sedation score in D group was significantly higher than that in C group(P<0.05),there was no difference in MMSE score between the two groups before anesthesia induction(P> 0.05),and the degree of reduction in D group was more significant than that in C group.There was no significant difference in the incidence of adverse reactions between the two groups(6.67% vs 13.33%)(P>0.05),and there was no significant adverse reaction.Conclusion Using DEX in elderly patients of endoscopic sinus surgery,with pre-injection 0.5ug/kg and continuous injection at a rate of 0.2-0.5ug/kg/h till 30 min before the operation finishing,can effectively reduce hemodynamic fluctuations and reduce the incidence of agitation during recovery period and improve the safety of anesthesia,without the disadvantage of prolonging the recovery and extubation time.
Objective To investigate influence of dexmedetomidine on postoperative awakening and cognitive function in elderly patients undergoing endoscopic sinus surgery.Methods 60 elderly patients of selective endoscopic sinus surgery were selected in hospital from April to November in 2016 and randomly divided into experiment group(D group)and control group(C group).In D group,the patients received intravenous injection of DEX(0.5ug/kg)before anesthesia induction,and then received continuous injection of DEX at a rate of 0.2-0.5ug/kg/h till 30 min before the operation finishing.In C group,physiological saline was used instead of DEX.Mean arterial blood pressure(MAP)and heart rate(HR)were determined before anesthesia(T0),during intubation(T1),1hour after operation(T2),during extubation(T3).The postoperative awaken time,agitation during awaken period,cognitive function and adverse reactions were observed.Results Changes of HR and MAP in D group had no obvious fluctuation.In C group,HR and MAP increased significantly at T1,T3.HR and MAP at T1,T2,T3 in D group were significantly lower than C group.Two groups of patients with spontaneous breathing recovery time,awake time and extubation time were no significant difference(P>0.05).The incidence of agitation and SAS scores were significantly higher in C group than those in D group(P<0.05).Sedation score in D group was significantly higher than that in C group(P<0.05),there was no difference in MMSE score between the two groups before anesthesia induction(P> 0.05),and the degree of reduction in D group was more significant than that in C group.There was no significant difference in the incidence of adverse reactions between the two groups(6.67% vs 13.33%)(P>0.05),and there was no significant adverse reaction.Conclusion Using DEX in elderly patients of endoscopic sinus surgery,with pre-injection 0.5ug/kg and continuous injection at a rate of 0.2-0.5ug/kg/h till 30 min before the operation finishing,can effectively reduce hemodynamic fluctuations and reduce the incidence of agitation during recovery period and improve the safety of anesthesia,without the disadvantage of prolonging the recovery and extubation time.
引文
[1] Dong J K,Sang H K,So K Y,et al.Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery[J]. BMC Anesthesiology,2015,15(1):1-11.
[2]佟凯.不同剂量右美托咪定对腹腔镜下结直肠癌手术苏醒期躁动及早期认知功能影响的研究[J].中国内镜杂志,2015,21(4):356-359.
[3]张静,胡晓云,关雷,等.右美托咪定对老年非心脏大手术患者苏醒期及术后谵妄的影响[J].中国实验诊断学,2015,18(6):924-926.
[4]杨帆,赵晓春,吴秀英.不同剂量右美托咪定对全麻鼻内镜手术患者苏醒质量的影响[J].实用药物与临床,2015,17(12):1448-1451.
[5]夏勇军,李军鹏,李萌,等.右美托咪定联合地佐辛对老年高血压患者全麻苏醒期躁动及血流动力学的影响[J].临床麻醉学杂志,2015,31(07):647-651.
[6]卢燕,何绮霞,莫坚,等.右美托咪定手术结束前滴鼻对全麻苏醒期应激反应的影响[J].实用医学杂志,2015,31(3):458-459.
[7]于铁莉,岳文慧,王金城,等.不同剂量右美托咪定在老年患者全麻苏醒期的应用[J].临床药物治疗杂志,2015,12(01):32-35.
[8] Lee J M,Lee S K,Lee S J,et al.Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty[J].Journal of International Medical Research,2016,44(2):264-266.
[9]刘志勇,刘资军,王明亮.右美托咪定对妇科腹腔镜手术患者全身麻醉苏醒期的影响[J].重庆医学,2015,43(23):3276-3277.
[10]高峰,吴雨佳.右美托咪定对静吸复合麻醉骨折手术患者苏醒期躁动及术后机械痛阈值的影响[J].山东医药,2016,56(28):100-102.
[11]刘莉,谭秦东,郭春华.右美托咪定对下腹部手术全麻患者苏醒期影响[J].解放军医药杂志,2015,26(2):82-84.
[12]施凌峰,唐鸣,沈泳坚,等.右美托咪定对功能性鼻内窥镜手术患者苏醒期质量的影响[J].医学临床研究,2016,33(3):516-518.
[13]李梦良,纪宇,胡志向.鼻窦内窥镜手术术中应用右美托咪啶对患者术后苏醒期的影响[J].中国医师进修杂志,2015,38(7):529-530.
[14]郎堡,王绍明,孙燕敏,等.右美托咪定对老年骨科手术患者全麻恢复及术后早期认知功能的影响[J].山东医药,2015,58(08):79-81.
[15]朱卓丽,邓玉萍,黄焕森.不同剂量右美托咪定输注对内窥镜鼻窦手术患者麻醉苏醒期的影响[J].中华生物医学工程杂志,2015,21(6):538-541.
[16]孙俊枝,解雅英,辛学东,等.右美托咪定对老年胸科手术患者脑氧饱和度及术后认知功能的影响[J].现代中西医结合杂志,2017,26(14):1580-1581.
[17]陈杰华,马海燕.维持剂量右美托咪定对行腹部手术的老年全麻患者术后认知功能影响[J].解放军医药杂志,2017,29(01):100-103.
[18] Cho J S,Kim H I,Lee K Y,et al.Effect of Intraoperative Dexmedetomidine Infusion on Postoperative Bowel Movements in Patients Undergoing Laparoscopic Gastrectomy:A Prospective,Randomized,Placebo-Controlled Study[J]. Medicine,2015,94(24):959.
[19]刘沁爽,孙东辉,戚小航.不同剂量盐酸右美托咪定对全髋关节置换术后老年患者术后早期认知功能的影响[J].河北医药,2015,43(24):3745-3747.
[20]方兆晶,赵倩,斯妍娜,等.右美托咪定对腹腔镜前列腺癌根治术老年患者局部脑氧饱和度和术后认知功能的影响[J].临床麻醉学杂志,2016,32(11):1049-1052.
[21]杨亦平,符新春,王华庆.右美托咪定对老年直肠癌患者全身麻醉拔管期血流动力学及术后认知功能的影响[J].中国临床保健杂志,2017,20(2):201-203.
[22]樊玉花,项明琼,马宇.右美托咪定对老年患者脊柱手术苏醒期躁动的影响[J].临床外科杂志,2016,24(8):626-628.
[23]朴云学,张井浪.术中持续输注右美托咪定对全麻手术患者术后认知功能的影响[J].江苏医药,2016,42(12):1335-1337.
[24] Tang C,Huang X,Kang F,et al.Intranasal Dexmedetomidine on Stress Hormones,Inflammatory Markers,and Postoperative Analgesia after Functional Endoscopic Sinus Surgery[J].Mediators of Inflammation,2015,2015(6):939431.
[25]宋晓媛,杨运萍,郭永清.右美托咪定对老年患者全麻苏醒期的影响[J].中国药物与临床,2015,14(5):690-691.
[26]庄萍,芦滨.盐酸右美托咪定注射液对老年胸外科手术患者麻醉苏醒期的影响[J].中国药房,2017,28(11):1523-1525.
[27]袁冬喜,董洪权,桂波.右美托咪定对老年患者全身麻醉拔管质量及苏醒时间的影响[J].江苏医药,2015,40(21):2539-2541.
[28]吴达丰,鲁亮,李思娟.右美托咪定对老年心血管病患者全麻下腹腔手术时麻醉苏醒期血流动力学指标的影响[J].心脑血管病防治,2016,16(6):462-464.
[29] Zhu M,Wang H,Zhu A,et al.Meta-analysis of dexmedetomidine on emergence agitation and recovery profiles in children after sevoflurane anesthesia:different administration and different dosage.[J].Plos One,2015,10(4):0123728.
[2]佟凯.不同剂量右美托咪定对腹腔镜下结直肠癌手术苏醒期躁动及早期认知功能影响的研究[J].中国内镜杂志,2015,21(4):356-359.
[3]张静,胡晓云,关雷,等.右美托咪定对老年非心脏大手术患者苏醒期及术后谵妄的影响[J].中国实验诊断学,2015,18(6):924-926.
[4]杨帆,赵晓春,吴秀英.不同剂量右美托咪定对全麻鼻内镜手术患者苏醒质量的影响[J].实用药物与临床,2015,17(12):1448-1451.
[5]夏勇军,李军鹏,李萌,等.右美托咪定联合地佐辛对老年高血压患者全麻苏醒期躁动及血流动力学的影响[J].临床麻醉学杂志,2015,31(07):647-651.
[6]卢燕,何绮霞,莫坚,等.右美托咪定手术结束前滴鼻对全麻苏醒期应激反应的影响[J].实用医学杂志,2015,31(3):458-459.
[7]于铁莉,岳文慧,王金城,等.不同剂量右美托咪定在老年患者全麻苏醒期的应用[J].临床药物治疗杂志,2015,12(01):32-35.
[8] Lee J M,Lee S K,Lee S J,et al.Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty[J].Journal of International Medical Research,2016,44(2):264-266.
[9]刘志勇,刘资军,王明亮.右美托咪定对妇科腹腔镜手术患者全身麻醉苏醒期的影响[J].重庆医学,2015,43(23):3276-3277.
[10]高峰,吴雨佳.右美托咪定对静吸复合麻醉骨折手术患者苏醒期躁动及术后机械痛阈值的影响[J].山东医药,2016,56(28):100-102.
[11]刘莉,谭秦东,郭春华.右美托咪定对下腹部手术全麻患者苏醒期影响[J].解放军医药杂志,2015,26(2):82-84.
[12]施凌峰,唐鸣,沈泳坚,等.右美托咪定对功能性鼻内窥镜手术患者苏醒期质量的影响[J].医学临床研究,2016,33(3):516-518.
[13]李梦良,纪宇,胡志向.鼻窦内窥镜手术术中应用右美托咪啶对患者术后苏醒期的影响[J].中国医师进修杂志,2015,38(7):529-530.
[14]郎堡,王绍明,孙燕敏,等.右美托咪定对老年骨科手术患者全麻恢复及术后早期认知功能的影响[J].山东医药,2015,58(08):79-81.
[15]朱卓丽,邓玉萍,黄焕森.不同剂量右美托咪定输注对内窥镜鼻窦手术患者麻醉苏醒期的影响[J].中华生物医学工程杂志,2015,21(6):538-541.
[16]孙俊枝,解雅英,辛学东,等.右美托咪定对老年胸科手术患者脑氧饱和度及术后认知功能的影响[J].现代中西医结合杂志,2017,26(14):1580-1581.
[17]陈杰华,马海燕.维持剂量右美托咪定对行腹部手术的老年全麻患者术后认知功能影响[J].解放军医药杂志,2017,29(01):100-103.
[18] Cho J S,Kim H I,Lee K Y,et al.Effect of Intraoperative Dexmedetomidine Infusion on Postoperative Bowel Movements in Patients Undergoing Laparoscopic Gastrectomy:A Prospective,Randomized,Placebo-Controlled Study[J]. Medicine,2015,94(24):959.
[19]刘沁爽,孙东辉,戚小航.不同剂量盐酸右美托咪定对全髋关节置换术后老年患者术后早期认知功能的影响[J].河北医药,2015,43(24):3745-3747.
[20]方兆晶,赵倩,斯妍娜,等.右美托咪定对腹腔镜前列腺癌根治术老年患者局部脑氧饱和度和术后认知功能的影响[J].临床麻醉学杂志,2016,32(11):1049-1052.
[21]杨亦平,符新春,王华庆.右美托咪定对老年直肠癌患者全身麻醉拔管期血流动力学及术后认知功能的影响[J].中国临床保健杂志,2017,20(2):201-203.
[22]樊玉花,项明琼,马宇.右美托咪定对老年患者脊柱手术苏醒期躁动的影响[J].临床外科杂志,2016,24(8):626-628.
[23]朴云学,张井浪.术中持续输注右美托咪定对全麻手术患者术后认知功能的影响[J].江苏医药,2016,42(12):1335-1337.
[24] Tang C,Huang X,Kang F,et al.Intranasal Dexmedetomidine on Stress Hormones,Inflammatory Markers,and Postoperative Analgesia after Functional Endoscopic Sinus Surgery[J].Mediators of Inflammation,2015,2015(6):939431.
[25]宋晓媛,杨运萍,郭永清.右美托咪定对老年患者全麻苏醒期的影响[J].中国药物与临床,2015,14(5):690-691.
[26]庄萍,芦滨.盐酸右美托咪定注射液对老年胸外科手术患者麻醉苏醒期的影响[J].中国药房,2017,28(11):1523-1525.
[27]袁冬喜,董洪权,桂波.右美托咪定对老年患者全身麻醉拔管质量及苏醒时间的影响[J].江苏医药,2015,40(21):2539-2541.
[28]吴达丰,鲁亮,李思娟.右美托咪定对老年心血管病患者全麻下腹腔手术时麻醉苏醒期血流动力学指标的影响[J].心脑血管病防治,2016,16(6):462-464.
[29] Zhu M,Wang H,Zhu A,et al.Meta-analysis of dexmedetomidine on emergence agitation and recovery profiles in children after sevoflurane anesthesia:different administration and different dosage.[J].Plos One,2015,10(4):0123728.