右美托咪定在老年患者内镜黏膜下剥离术中的应用

Application of dexmedetomidine in elderly patients during ESD operation

目的:探讨右美托咪定在老年患者内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)手术中的应用。方法:将60例在本院进行ESD手术的老年患者分为研究组和对照组,每组30例。研究组术前给予泵注0.5μg/kg的右美托咪定。对照组给予等量的生理盐水。术中,两组均持续输注丙泊酚。对比两组手术时间、麻醉时间、苏醒时间、丙泊酚用量。分别于术前、术后6h、术后1 d、术后3 d,采用简易智力状态检查表(MMSE)评估患者认知功能变化,同时评估术后认知功能障碍(POCD)的发生情况。结果:两组手术时间、麻醉时间对比,差异无统计学意义(P>0.05);研究组的苏醒时间、丙泊酚用量显著低于对照组,差异有统计学意义(P<0.05);术后6h、术后1 d、术后3 d,观察组MMSE评分的显著高于对照组,差异有统计学意义(P<0.05);术后6 h、术后1 d、术后3 d,研究组的POCD发生情况显著轻于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率(6.67%)显著低于对照组(30.00%),差异有统计学意义(P<0.05)。结论:右美托咪定对老年患者ESD手术后的认知功能具有保护作用。

AIM： To investigate the effects of dexmedetomidine in elderly patients with endoscopic submucosal dissection （endoscopic submucosal dis- section, ESD） used in operation. METHODS ： Six- ty elderly patients who underwent ESD operation in our hospital were divided into study group and con- trol group, each group included 30 cases. The study group was given 0.5 μg/kg infusion of dexmedeto- midine. The control group was given the same a- mount of saline. During operation, two groups were- given continuous infusion of propofol. The operation time, anesthesia time, recovery time, propofol dos- age were compared between the two groups. Post-op- erative cognitive function （POCD） was assessed by mini mental state examination （MMSE） before and 6 hours after operation, on the postoperative day 1 and day 3 after operation, and the incidence of POCD was assessed. RESULTS：Comparison of op- eration time, anesthesia time in two groups. The difference was not statistically significant （P 〉 0.05）. The recovery time and propofol dosage in the study group were significantly lower than those in the control group. The difference was statistically significant （P 〈 0.05 ）. Postoperative 6 hours, post- operative day 1, postoperative day 3, the observa- tion group MMSE score was significantly higher than that of the control group. The difference was statisti- cally significant （P 〈 0.05 ）. Postoperative 6 hours, postoperative day 1, postoperative day 3, the study group POCD was significantly lighter than that of the control group. The difference was statistically signifi- cant （ P 〈 0.05 ）. The incidence of adverse reac- tions in the study group （6.67%） was significantly lower than that in the control group （30%）. The difference was statistically significant （ P 〈 0.05 ）. CONCLUSION： Dexmedetomidine has a protective effect on cognitive function in elderly patients after ESD surgery.