右美托咪定在老年患者经尿道前列腺电切术中的应用效果

Application effect of Dexmedetomidine in elderly patients with transurethral resection of prostate

目的探讨右美托咪定对老年前列腺电切术(TURP)患者血流动力学、炎症因子、术后认知功能障碍(POCD)及谵妄的影响。方法将鹤壁煤业(集团)有限责任公司总医院2020年1月—2021年3月收治的80例老年TURP患者随机分为观察组(n=40)和对照组(n=40)观察组静脉泵注0.8μg/(kg·h)右美托咪定15分钟,对照组静脉泵注等量生理盐水。比较两组患者的手术指标,不同时刻[插管前(T_(0))、气管插管即刻(T_(1))、手术开始时(T_(2))和手术开始30 min时(T_(3))]血流动力学[平均动脉压(MAP)和心率(HR)],细胞因子[肿瘤坏死因子(TNF-α)、白细胞介素1β(IL-1β)和超敏C-反应蛋白(hs-CRP)]水平,POCD及谵妄发生率。结果比较两组患者的手术指标,均无统计学意义(P>0.05);观察组患者T_(1)、T_(2)和T_(3)时刻的MAP和T1时刻的HR显著低于对照组(P<0.05);观察组和对照组患者术后1 d的TNF-α和IL-1β水平较术前显著升高(P<0.05),hs-CRP水平较术前降低(P<0.05);观察组患者术后1 d的TNF-α、IL-1β和hs-CRP水平显著低于对照组(P<0.05);术后观察组和对照组患者MMSE评分较术前显著降低(P<0.05);且观察组患者MMSE评分显著高于对照组(P<0.05),谵妄发生率显著低于对照组(P<0.05)。结论术前采用右美托咪定辅助麻醉,可使老年TURP患者MAP和HR更加平稳,显著降低患者术后炎症因子水平,POCD及谵妄的发生率。

Objective To investigate the effect of dexmedetomidine on hemodynamics,inflammatory factors,postoperative cognitive dysfunction(POCD)and postoperative delirium after transurethrue resection of prostate(TURP)in elderly patients.Methods A total of 80 elderly patients who underwent transurethral resection of the prostate from May 2017 to May 2019 in our hospital were randomly assigned to observation group and control group(n=40/per group).Patients in observation group were pumped dexmedetomidine 0.8μg/(kg·h)through intravenous infusion within 15 min,while patients in control group were pumped the same volume of normal saline.The surgery indexes,mean arterial pressure(MAP)and heart rate(HR)at different times(before infusion of dexmedetomidine(T_(0)),endotracheal intubation(T_(1)),beginning of surgery(T_(2)),and 30 min after operation(T_(3))),the levels of cytokines(tumor necrosis factor-α(TNF-α),interleukin-1 beta(IL-1β)and high-sensitivity C-reactive protein(hs-CRP)),POCD and postoperative delirium incidence were compared between two groups.Results No statistically significant differences were observed in surgery indexes between two groups(P>0.05).MAP at T_(1),T_(2)and T_(3)and HR at T_(2)were significantly decreased in observation group compared with control group(P<0.05).On postoperative day 1,the levels of TNF-αand IL-1βwere increased,the level of hs-CRP were decreased,compared with preoperative levels in observation and control groups(P<0.05);On postoperative day 1,the levels of TNF-α,IL-1βand hs-CRP were decreased in observation group compared with and control group(P<0.05).MMSE scores after operation were significantly decreased compared with preoperative levels in observation and control groups(P<0.05),and MMSE score of observation group after operation was significantly increased compared with control group(P<0.05).The incidence of postoperative delirium(10%)was significantly lower in observation group than that in control group(P<0.05).Conclusion The elderly TURP patients treated by dexmedetomidine for auxiliary anesthesia before operation,can make the MAP and HR more stable,and significantly reduce the level of postoperative inflammatory factors,incidence of POCD as well as postoperative delirium.