小剂量纳美芬对老年腹腔镜结直肠癌根治病人术后苏醒的影响

Effects of a small dose of nalmefene on recovery in elderly patients undergoing radical laparoscopic resection of colorectal cancer

目的观察小剂量纳美芬在行全麻腹腔镜结直肠癌根治术的老年病人术后苏醒期的应用效果。方法将全麻下拟行腹腔镜结直肠癌根治术的老年病人60例随机分为对照组及纳美芬组,术毕2组病人分别经静脉给予生理盐水及纳美芬0.15μg/kg。观察并记录2组病人术毕呼吸恢复时间、拔出气管导管时间、术后血流动力学变化、拔管后Ramsay评分、视觉模拟(VAS)评分及术后并发症的发生率。比较2组病人手术结束时及拔管后20 min动脉血p H值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及血糖的变化。结果纳美芬组呼吸恢复时间及拔管时间显著低于对照组(P<0.05);纳美芬组拔管后20 min PaO_2及PaCO_2分别为(89.3±2.4)mm Hg、(40.3±1.8)mm Hg,对照组病人拔管后20 min PaO_2及PaCO_2分别为(83.0±2.3)mm Hg、(44.7±1.9 mm)Hg,差异均有统计学意义(P<0.05);纳美芬组术后呼吸抑制及恶心呕吐的发生例数显著少于对照(P<0.05)。术毕2组血糖及各时点血流动力学变化、Ramsay评分、VAS评分及术后躁动的发生差异均无统计学意义。结论小剂量纳美芬用于老年病人腹腔镜结直肠癌根治术后,能缩短病人术后拔管时间,促进病人呼吸的恢复,减少麻醉复苏时间,且血流动力学平稳,不良反应少,安全性高。

Objective To evaluate the effects of a small dosage of nalmefene on recovery in elderly patients with colorectal cancer undergoing radical laparoscopic resection. Methods Sixty ASAⅡ-Ⅲ elderly patients aged 65-78 years old scheduled for elective radical laparoscopic resection of colorectal cancer were randomly divided into two groups,with 30 cases in each group. The patients were given intravenous injection of saline or 0. 15 μg/kg of nalmefene respectively in control group or nalmefene group after operation. Respiration recovery time and extubation time were recorded. The levels of arterial blood p H,arterial partial pressure of oxygen（ PaO2）,arterial carbon dioxide partial pressure（ PaCO2） and blood glucose were compared between the two groups at the end of surgery and 20 min after extubation. Results Respiration recovery time and extubation time in nalmefene group were significantly lower than those in control group（ P〈0. 05）. PaO2 and PaCO2 of nalmefene group after extubation were 89. 3±2. 4 mm Hg and 40. 3 ± 1. 8 mm Hg respectively,compared with 83. 0 ± 2. 3 mm Hg and 44. 7 ± 1. 9 mm Hg in control group（ P〈0. 05）. The incidence rate of postoperative respiratory depression,nausea and vomiting were statistically different between the two groups（ P〈0. 05）. There was no significant difference in the hemodynamic changes,Ramsay scores,VAS scores,the incidence of postoperative agitation and blood glucose between the two groups after operation. Conclusions A small dosage of nalmefene can shorten the time of extubation,promote respiration recovery,reduce the recovery time of anesthesia and has hemodynamic stability, with less adverse reaction in elderly patients undergoing radical laparoscopic resection of colorectal cancer.