右美托咪定对老年胸腔镜肺癌根治术患者拔管时血流动力学及术后疼痛的影响

A Study on the Effect of Dexmedetomidine on the Hemodynamics and Postoperative Pain in Elderly Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

目的:探讨右美托咪定对老年胸腔镜肺癌根治术患者拔管时血流动力学以及术后疼痛的影响。方法:选取67例择期行胸腔镜肺癌根治术的老年患者,根据随机数字表法分为对照组(n=33例)和研究组(n=34例),均予咪达唑仑、顺苯磺酸阿曲库铵、舒芬太尼、丙泊酚麻醉诱导,对照组同时予15 mL生理盐水静脉注射,研究组同时予0.5μg/kg右美托咪定静脉注射(15 min),术毕后均开启自控静脉镇痛(PCIA)泵。监测两组诱导前(T_0)、诱导后5 min(T_1)、入PACU时(T_2)、拔管即刻(T_3)、拔管后5 min(T_4)血流动力学指标,评估出PACU时(T_5)、术后2 h(T_6)、术后4 h(T_7)、术后6 h(T_8)、术后12 h(T_9)、术后24 h(T_10)疼痛视觉模拟量表(VAS)评分,检测T_0、T_8、T_9、T_10动脉血气评价肺功能,同时比较拔管时间、拔管质量评分、镇痛泵按压次数、24 h舒芬太尼用量及围术期不良反应。结果:与T0相比,对照组T_3、T_4时平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)升高(P<0.05),研究组T_3时MAP、HR、CVP升高(P<0.05),与对照组相比,研究组T_3、T_4时MAP、HR、CVP较低(P<0.05);与对照组相比,研究组T_6、T_7、T_8、T_9、T_10时VAS评分较低(P<0.01);两组T_8、T_9、T_10时Qs/Qt升高(P<0.05),OI、PaO_2/PAO_2降低(P<0.05),与对照组相比,研究组T8、T9、T10时Qs/Qt较低(P<0.05),OI、PaO_2/PAO_2较高(P<0.05);与对照组相比,研究组拔管质量评分未见差异(P>0.05),镇痛泵按压次数较少(P<0.05),24 h舒芬太尼用量较少(P<0.01)。结论:右美托咪定可明显稳定老年胸腔镜肺癌根治术拔管期血流动力学,并有较好的术后镇痛效果,一定程度上改善患者术后肺功能。

Objective： To investigate the effect of dexmedetomidine on the hemodynamics and postoperative pain in elderly patients undergoing thoracoscopic radical resection of lung cancer. Methods： 67 cases of elderly patients undergoing thoracoscopic radical resection of lung cancer were randomly divided into the control group（n=33 cases） and the study group（n=34 cases）, both groups were given midazolam, CIS atracurium, sufentanil, propofol anesthesia, the control group was given saline intravenous 15 mL, and the study group was given 0.5 μg/kg dexmedetomidine intravenous injection（15 min）, patient-controlled intravenous analgesia（PCIA） pump were given to both groups after open surgery. The hemodynamic index were detected at before induction（T_0）, 5 min after induction（T_1）,PACU（T_2）, extubation（T_3）, 5 min after extubation（T_4）, pain visual analogue scale（VAS） score were compared at PACU（T_5）, 2 h after operation（T_6）, 4 h after operation（T_7）, 6 h after operation（T_8）, 12 h after operation（T_9）, 24 h postoperative（T_10）, arterial blood gas indexed were compared at T_0, T_8, T_9,T_10, and extubation time, extubation quality score, analgesic pump press times, 24 h sufentanil dosage and perioperative adverse reactions were compared. Results： Compared with T_0, the mean arterial pressure（MAP）, heart rate（HR）,central venous pressure（CVP） at T_3, T_4 in control group were increased（P0.05）, the MAP, HR and CVP at T_3 in the study group were increased（P0.05）, compared with the control group, the VAS scores at 2 h after operation（T_6）, 4 h after operation（T_7）, 6 h after operation（T_8）, 12 h after operation（T_9）, 24 h postoperative（T_10） in the study group were lower（P0.05）, the Qs/Qt increased at T_8, T_9 and T_10 in both groups（P0.05）, OI and PaO_2/PAO_2 were decreased（P0.05）. Compared with the control group, the Qs/Qt were lower at T_8, T_9 and T_10 in study group（P0.05）, the OI and PaO_2/PAO_2 were higher（P0.05）. Compared with the control group, there was no significant difference in the quality of extubation in the study group（P0.05）, and the number of pain pump pressing and amount of 24 h sufentanil werelower（P0.05）. Conclusion： Dexmedetomidine can obviously stabilize the hemodynamics of elderly patients undergoing thoracoscopic radical resection of lung cancer during the extubation period, and have better postoperative analgesic effect.