右美托咪定对肺癌根治术患者术后谵妄的预防作用

Preventive effects of dexmedetomidine assisted anesthesia on postoperative delirium in patients with radical resection of pulmonary carcinoma

目的术后谵妄不利于患者预后,通过观察右美托咪定辅助麻醉对肺癌根治术患者术后谵妄发生率的影响,探讨该药对术后谵妄的预防作用。方法拟行择期肺癌根治术患者90例,随机均分为右美托咪定麻醉组(试验组,负荷剂量1μg/kg,维持剂量0.2μg/(kg·h)和常规麻醉组(对照组,同样体积外观的生理盐水代替),每组45例。记录术后2组苏醒时间、拔管时间以及围术期丙泊酚和芬太尼使用量,并随访统计术后当天(T1)、24 h(T2)和48 h(T3)3个时间点的谵妄发生率(CAM-CR法)。结果试验组在术后24 h(T1)、48 h(T2)的术后谵妄发生率(4.44%,0)低于对照组,差异具有统计学意义(χ2=4.05,P=4.46;χ2=0.04,P=0.03);同时试验组患者苏醒时间(17.81±6.62)min、拔管时间(24.26±7.43)min以及丙泊酚使用量(945.32±59.66)mg、芬太尼使用量(241.28±39.46)μg均低于对照组,差异具有统计学意义(t=5.72,P=0.00;t=4.28,P=0.00;t=4.33,P=0.01;t=8.50,P=0.00)。结论右美托咪定辅助麻醉可降低肺癌根治术患者术后谵妄的发生率,具有一定的预防作用,而且可缩短苏醒时间、拔管时间,减少丙泊酚、芬太尼的使用量。

Objective Postoperative delirium wasn＇t conducive to prognosis,this study investigated the efficacy of dexmedetomidine assisted anesthesia on prevent postoperative delirium in patients with pulmonary cancer,to explore the preventive effect of dexmedetomine. Methods Ninety patients who were underwent elective radical resection of pulmonary carcinoma were randomized into the dexmedetomidine anesthesia group（ Group Trial,loading dose of 1 μg /kg,maintenance dose of 0. 2 μg /（ kg·h） and the regular anesthesia group（ Group Control,physiological saline of the same volume）. The presence of delirium at 24 h（ T1）,48 h（ T2）,72 h（ T3） after surgery,and the recovery time,extubation time and the usage amount of propofol or fentanyl were recorded. Results The incidence of delirium at 24 h（ T1）,48 h（ T2） after surgery（ 4. 44%,0） was significantly lower in the Group Trial than that in the Group Contorl（ χ^2= 4. 05,P = 4. 46; χ^2=0. 04,P = 0. 03）. The recovery time（ 17. 81 ± 6. 62） min,extubation time（ 24. 26 ± 7. 43） min and the usage amount of propofol（ 945. 32 ± 59. 66） mg or fentanyl（ 241. 28 ± 39. 46） μg were lower in the Group Trial than that in the Group Control（ t = 5. 72,P = 0. 00; t = 4. 28,P = 0. 00; t = 4. 33,P = 0. 01; t = 8. 50,P = 0. 00）. Conclusion Dexmedetomidine assisted anesthesia may reduce the presence of postoperative delirium and the recovery time,extubation time and the usage amount of propofol or fentanyl,and had some preventive effect.