摘要
目的:探究右美托咪定在合并衰弱的患者腹腔镜全子宫切除术麻醉中的围术期镇静效果及安全性。方法:纳入2019年1月-2023年12月腹腔镜下全子宫切除术合并衰弱患者86例,患者Frail衰弱评估量表评分3~5分。双色球法分组为常规组(n=43),接受常规麻醉:咪达唑仑0.1mg/kg、舒芬太尼0.4μg/kg和罗库溴铵0.6mg/kg,麻醉维持方案为丙泊酚2.5~5mg/kg/h静脉泵注,舒芬太尼0.2μg/kg间断静脉泵注,根据患者术中情况追加顺罗库溴铵0.2mg/kg;观察组(n=43)加用右美托咪定:予右美托咪定0.5μg/kg,在麻醉诱导前10min静脉泵注,之后行常规麻醉诱导、机械辅助呼吸;麻醉维持方案加用右美托咪定1.0μg/kg/h,其余同常规组。对比两组围术期指标、血流动力学、应激反应、血清Th1/Th2细胞因子变化、术后睡眠监测情况及不良反应。结果:观察组首次按压镇痛泵时间晚于常规组,术后48h镇痛泵按压次数、补救镇痛率、恢复正常进食时间均少于常规组(均P<0.05),两组下床时间无差异(P>0.05);在手术期间观察组收缩压、舒张压及心率变化幅度均低于常规组(P<0.05);术后1d,较术前两组对抗凝血酶Ⅲ、总抗氧化态水平均降低、丙二醛水平均升高,两组Th1、Th1/Th2水平均升高、Th2水平均降低,但观察组变化幅度均低于常规组(P<0.05)。睡眠质量监测,两组在M3、REM无差异(P>0.05),观察组M 1、觉醒指数低于常规组,M2、睡眠效率、主观睡眠质量评分高于常规组(均P<0.05);两组低血压、心动过缓发生情况无差异(P>0.05),观察组术后谵妄、认知障碍的发生率均低于常规组(P<0.05)。结论:右美托咪定应用于合并衰弱行腹腔镜全子宫切除术患者中,可以改善围术期镇静效果,优化疼痛管理,提高血流动力学稳定性,减轻手术应激,改善睡眠质量,并降低术后谵妄和认知障碍风险。
Objective: To investigate the perioperative sedation effect and the safety of dexmedetomidine used in the laparoscopic total hysterectomy of patients with frailty. Methods: 86 patients with frail(3-5 points evaluated by frail scale score) who wanted laparoscopic total hysterectomy were included and were divided into two groups(43 cases in each group) by the double chromosphere method from January 2019 to December 2023. The patients in the two groups received conventional anesthesia of 0.1mg/kg midazolam, 0.4μg/kg sufentanyl and 0.6mg/kg rocuronium, the anesthesia maintenance protocol of 2.5 to 5 mg/kg/h propofol intravenous pump infusion and sufentanil 0.2μg/kg intermittent intravenous pump infusion, and rocuronium 0.2mg/kg added according to the intraoperative condition. The patients in the observation group were given dexmedetomidine additionally, including 0.5μg/kg dexmedetomidine intravenous venous infusion at 10min before anesthesia induction, and then the conventional anesthesia induction and mechanical assisted respiration used,and dexmedetomidine 1.0μg/kg/h also used in the anesthesia maintenance protocol.The values of the perioperative,hemodynamic and stress response indicators,the changes of the serum Th1/Th2cytokines,the postoperative sleep monitoring situation and the incidence of adverse reactions of the patients were compared between the two groups.Results:The time of the first pressing analgesic pump of the patients in the observation group was significantly later than that of the patients in the control group.The number of analgesic pump pressing in 48hafter surgery,the rate of rescue analgesia and the time of resuming normal eating of the patients in the observation group were significantly less than those of the patients in the control group(all P<0.05).There was no significant difference in the time of getting out of bed of the patients between the two groups(P>0.05).During the operation,the variation amplitude of the systolic blood pressure,diastolic blood pressure and heart rate of the patients in the observation group were significantly lower than those of the patients in the control group(P<0.05).In the first day after operation,the levels of antithrombinⅢ,total antioxidant state and Th2of the patients in the two groups had decreased significantly and the levels malondialdehyde,Th1and Th1/Th2of the patients in the two groups had increased significantly,and the variation amplitude of which of the patients in the observation group were significantly lower than those of the patients in the control group(P<0.05).In the sleep quality monitoring,the values of M3and REM of the patients had no significant difference between the two groups(P>0.05).The values of M 1and arousal index of the patients in the observation group were significantly lower than those of the patients in the control group,and the M2value,the sleep efficiency and the subjective sleep quality score of the patients in the observation group were significantly higher than those of the patients in the control group(all P<0.05).There was no significant difference in the incidences of hypotension and bradycardia of the patients between the two groups(P>0.05).The incidences of the postoperative delirium and cognitive impairment of the patients in the observation group were significantly lower than those of the patients in the control group(P<0.05).Conclusion:Dexmedetomidine used in the laparoscopic total hysterectomy of the patients with frailty can improve their perioperative sedation,optimize their pain management,enhance their hemodynamic stability,alleviate their surgical stress,improve their sleep quality,and decrease the risk of their postoperative delirium and cognitive impairment.
作者
季如意
吴凡
马铜建
高鹏飞
余宗圣
JI Ruyi;WU Fan;MA Tongjian;GAO Pengfei;YU Zongsheng(The People's Hospital of Quanjiao,Chuzhou,Anhui Province,239500;Chaohu Hospital of Anhui Medical University,Chaohu,Anhui Province)
出处
《中国计划生育学杂志》
2025年第2期289-294,共6页
Chinese Journal of Family Planning
