【罂粟摘要】不同剂量右美托咪定对腹腔镜全子宫切除术患者早期认知功能的影响

不同剂量右美托咪定对腹腔镜全子宫切除术患者早期认知功能的影响

贵州医科大学 麻醉与心脏电生理课题组

翻译：安丽  编辑：佟睿   审校：曹莹

背景

本研究旨在分析不同剂量右美托咪定对接受腹腔镜广泛全子宫切除患者术后早期认知功能的影响。

方法

选择在厦门大学附属妇幼医院，2019年1月至2020年6月接受腹腔镜下广泛全子宫切除术119例妇科肿瘤患者进行研究。A组于诱导前10 min静脉注射咪达唑仑0.05mg/kg。麻醉诱导:依托咪酯0.3 mg/kg、舒芬太尼0.4-0.6μg /kg、顺阿曲库铵0.15 mg/kg后气管插管，插管后持续泵注咪达唑仑0.5μg/(kg·min)至手术结束前30分钟。B组、C组、D组于麻醉诱导前10分钟静脉注射右美托咪定，剂量分别为1μg/kg、0.5μg/kg、0.25μg/kg，三组均泵注右美托咪定0.2μg/(kg·h)至手术结束前30分钟。气管导管后接麻醉机，并监测PETCO₂，麻醉趋势脑电图/意识麻醉深度。比较各组术前(T₀)、术后1d(T₁)及术后3(T₂)、7d(T₃) 痴呆量表MoCA评分及TNF-a、IL-6、S-100蛋白、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白（GFAP）水平。

结果

四组患者给予瑞芬太尼、舒芬太尼和异丙酚的用量分别:A组>D组>C组>B组。四组在恢复室的时间、拔管时间和麻醉恢复时间A组 > D组 > C组，B组和C组之间的差异不显著（>0.05）。与A组相比，B组在术后1天（T₁）、3天（T₂）和7天（T₃）的MoCA评分较高（P<0.05）。在同一时点，MoCA评分：B组 > C组 > D组 > A组。四组POCD均发生在术后3天。与T₀点相比，四组在T₁和T₂时的TNF-和IL-6水平显著升高（P<0.05）。T₃时，TNF-a和IL-6水平逐渐降低。在不同时期，B、C、D组S-100蛋白、NSE、GFAP水平均低于A组（P<0.05）。B组的心动过缓发生率明显高于其他三组（P<0.05）。A组寒颤、呼吸抑制和躁动的发生率与其他三组有显著性差异(P<0.05)。

结论

腹腔镜下广泛全子宫切除术，使用0.5μg/kg右美托咪定可有效减少患者麻醉药物用量。有助于减少不良反应和POCD的发生，同时对大脑功能有一定的保护。

原始文献来源

HuiqiongHuang, XiuyiXu, YirongXiao, andJunxiangJia.The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy.Journal of Healthcare Engineering.Volume 2021, Article ID 3531199, 9 pages

The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy

Abstract

Background:This study aims to analyze the influence of different dexmedetomidine doses on cognitive function. It works on early periods of patients undergoing laparoscopic extensive total hysterectomy.

Method:119 patients with gynecological cancer underwent a laparoscopic extensive total hysterectomy. The operation was performed at the Affiliated Women's and Children's Hospital of Xiamen University from January 2019 to June 2020. The score of MoCA and the level of TNF-, IL-6, S-100 protein, NSE, and GFAP of each group were compared 1 day before and after operation and 3 and 7 days after operation.

Result: In four groups, remifentanil, sufentanil, and propofol were given in the following order: group A > group D > group C > group B. Group A > group D > group C in terms of time spent in the recovery room, extubation, and recovery from anesthesia. The difference between groups B and C was not significant ( > 0.05). Compared with group A, group B scored higher in MoCA at 1 day (T1), 3 days (T2), and 7 days (T3) after operation ( < 0.05). At the same scoring point, the score was group B > group C > group D > group A. The POCD of four groups all occurred at 3 days after surgery. Compared with the T0 point, the level of TNF- and IL-6 of the four groups at T1 and T2 was significantly increased ( < 0.05). At T3, the level of TNF- and IL-6 gradually decreased. At various periods, the levels of S-100 protein, NSE, and GFAP in groups B, C, and D were lower than those in group A (P0.05). Group B had a substantially higher rate of bradycardia than the other three groups (P0.05). The incidence of chills, respiratory depression, and restlessness in group A differed significantly from the other three groups ( < 0.05).

Conclusion: Using 0.5 g/kg dexmedetomidine during the perianaesthesia can effectively reduce anesthetic drugs in patients. They had a laparoscopic extensive complete hysterectomy, which helps to reduce the adverse responses and the occurrence of POCD while also protecting brain function.

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