摘要
目的 探讨不同剂量右美托咪啶对合并脑梗死的老年结肠癌患者围术期心肌功能和认知功能的作用。方法 选取2018年1月至2021年1月间陕西省安康市中心医院收治的87例老年结肠癌合并脑梗死患者,均采用腹腔镜结肠癌根治术治疗,分为右美托咪定1组23例、右美托咪定2组22例、右美托咪定3组22例和对照组20例。1组、2组、3组患者分别在麻醉诱导前给予负荷剂量醋酸地塞米松0.3μg/kg、0.5μg/kg和0.7μg/kg静脉泵注15min,术中维持剂量为0.3μg·kg^(-1)·h^(-1)、0.5μg·kg^(-1)·h^(-1)和0.7μg·kg^(-1)·h^(-1),对照组给予等量生理盐水。比较四组患者围术期心肌功能、心脏不良反应和认知功能情况。结果 术前1d,四组患者高敏感肌钙蛋白(hs-TnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)和乳酸脱氢酶(LDH)各项指标比较,差异无统计学意义(P>0.05)。术后1d和3d, 1组、2组、3组的hs-TnT和CK水平均低于对照组;术后1d, 1组、2组、3组的CK-MB水平均低于对照组和术前1d,差异均有统计学意义(均P<0.05)。术前,四组患者心肌缺血情况比较,差异无统计学意义(P>0.05)。术中,对照组患者心肌缺血情况均高于1组、2组、3组,差异均有统计学意义(均P<0.05)。术后,对照组患者心肌缺血、心肌缺血+室速、心肌缺血+房颤、心肌梗死和心力衰竭等心脏不良反应发生率均高于1组、2组和3组,差异均有统计学意义(均P<0.05)。术前,四组患者简易智力状态检查量表(MMSE)评分比较,差异无统计学意义(P>0.05)。术后1d,四组患者MMSE评分均下降,且1组、 2组、3组评分均高于对照组,差异均有统计学意义(均P<0.05)。术后3d, 1组、2组、3组评分均高于对照组,但与术前相比,差异无统计学意义(P>0.05)。对照组术后3d评分与术前相比,差异有统计学意义(P<0.05)。结论 右美托咪定能够有效改善脑梗死合并结肠癌老年患者围术期的心肌功能和认知功能,降低心脏不良反应发生率,但实践中应坚持个体化用药,保证治疗效果。
Objective To investigate the effects of different doses of dexmedetomidine on perioperative myocardial function and cognitive function in elderly patients with colon cancer and cerebral infarction. Methods A total of 87 elderly patients with colon cancer and cerebral infarction who were admitted to Ankang Central Hospital from January 2018 to January 2021 were selected. All patients received laparoscopic radical resection for colon cancer. They were divided into dexmedetomidine group 1(23 patients), dexmedetomidine group 2(22 patients), dexmedetomidine group 3(22 patients) and a control group(20 patients). Dexmedetomidine group 1, 2 and 3 was intravenously given loading doses of 0.3, 0.5 and 0.7 μg/kg dexmedetomidine before induction of anesthesia. using pumps for 15 min, and the intraoperative maintenance dose is 0.3, 0.5 and 0.7 μg/kg per hour. The control group is given equivalent saline. The perioperative myocardial function, adverse cardiac events, and cognitive function were compared among the four groups. Results At 1 d before the operation, there was no significant difference in high sensitivity troponin T(hs-TnT), creatine kinase(CK), CK-MB, aspartate aminotransferase(AST) and lactate dehydrogenase(LDH) among the four groups(P>0.05). At 1 d and 3 d after the operation, hs-TnT and CK were lower in groups 1, 2 and 3 than in the control group(all P<0.05). At 1 d after the operation, CK-MB was lower in groups 1, 2 and 3 than in the control group and lower than those at 1 d before the operation(all P<0.05). Before the operation, there was no significant difference in the incidence of myocardial ischemia among the four groups(P>0.05). During the operation, the incidence of myocardial ischemia was higher in the control group than in the rest three groups(all P<0.05). After the operation, the incidence of adverse cardiac events including myocardial ischemia, myocardial ischemia complicated with ventricular tachycardia, myocardial ischemia complicated with atrial fibrillation, myocardial infarction and heart failure was higher in the control group than in the rest three groups(all P<0.05). Before the operation, there was no significant difference in mini-mental state examination(MMSE) score among the four groups(P>0.05). After the operation, MMSE score decreased significantly in the four groups and the scores were significantly higher in groups 1, 2, and 3 in the control group(all P<0.05). Compared with preoperative MMSE scores, the difference is not significant(P>0.05). There was still a statistical difference in MMSE scores in the control group at 3 d after the operation compared with that before the operation(P<0.05). Conclusion Dexmedetomidine can effectively improve perioperative myocardial function and cognitive function, and reduce the incidence of adverse cardiac events in elderly patients with cerebral infarction and colon cancer. However, in specific practice, use of medicine should be individualized to ensure the therapeutic effect.
作者
姜蓉
肖晖
JIANG Rong;XIAO Hui(Department of Anesthesiology,Ankang Central Hospital,Ankang 725000,China)
出处
《中国肿瘤临床与康复》
2022年第7期843-846,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
右美托咪定
老年结肠肿瘤患者
围术期
心肌功能
认知功能
Dexmedetomidine
Elderly patients with colon neoplasms
Perioperative period
Myocardial function
Cognitive function
