不同剂量右美托咪定对老年妇科恶性肿瘤手术患者围手术期的影响

The effects of different doses of dexmedetomidine in elderly patients with malignant tumors undergoing gynecological surgery

目的探讨不同剂量右美托咪定对老年妇科恶性肿瘤手术患者围手术期疼痛、认知功能及肾功能的影响。方法选取手术治疗的妇科恶性肿瘤患者115例,采用随机数字表法将其分为A组(35例)、B组(40例)、C组(40例),A组和B组在进行麻醉诱导前10 min内均给予1.0μg/kg右美托咪定静脉注射,之后分别以0.4、0.8μg/(kg·h)右美托咪定静脉滴注至手术结束前30 min,C组患者给予等量生理盐水。比较三组患者围手术期的视觉模拟评分(VAS)、简易智力状态检查量表(MMSE)评分、血浆中性粒细胞明胶酶相关载脂蛋白(NGAL)水平及尿量。结果三组术后3、6 h VAS评分均低于术后1 h,B组术后3、6 h VAS评分低于A、C两组;A、B组术后1 d MMSE评分均低于麻醉前1 d,且B组高于A、C两组(P<0.05);三组术后2 h血浆NGAL水平均高于术前,但低于术后24 h(P<0.05),A组术后2、24 h血浆NGAL水平明显低于B、C两组(P<0.05);三组术后120 min尿量高于气腹120 min内,A组气腹120 min内、术后120 min内尿量高于B、C两组(P<0.05)。结论相较于0.4μg/(kg·h)右美托咪定,术前给予0.8μg/(kg·h)右美托咪定静脉滴注更能减轻老年妇科恶性肿瘤患者的围手术期疼痛程度,并且可改善其认知功能,但对患者肾功能的影响较大。

Objective To investigate the effects of different doses of dexmedetomidine on perioperative pain,cognitive function and renal function in elderly patients with malignant tumors undergoing gynecological surgery.Methods A total of 115 patients with malignant tumors who underwent surgical treatment were enrolled.They were divided into group A(n=35),group B(n=40)and group C(n=40)by random number table.The group A and B were given intravenous injection of 1.0μg/kg dexmedetomidine before 10 minutes of anesthesia induction,and then given intravenous drip of 0.4μg/(kg·h)and 0.8μg/(kg·h)dexmedetomidine,respectively.The intravenous drip was lasted until 30 minutes before the end of surgery.The group C was given the same amount of normal saline.The perioperative scores of visual analogue scale(VAS)and mini-mental state examination(MMSE)were compared among the three groups.The changes in renal function indexes such as level of plasma neutrophil gelatinase-associated apolipoprotein(NGAL)and urine volume in all groups were observed.Results VAS scores after 3 and 6 hours of surgery were lower than those after 1 hour of surgery in the three groups.VAS scores after 3 and 6 hours of surgery in the group B were lower than those in groups A and C(P<0.05).MMSE scores after 1 day of surgery were lower than those before 1 day of anesthesia in the group A and B.MMSE scores after 1 day of surgery in the group B were higher than those in the group A and C(P<0.05).The levels of plasma NGAL after 2 hour of surgery were higher than those before surgery in the three groups,while levels of plasma NGAL after 24 hours of surgery were lower than those after 2 hours of surgery(P<0.05).The levels of plasma NGAL after 2 and 24 hours of surgery in the group A were significantly lower than those in the group B and C(P<0.05).The urine volume after 120 min of surgery was more than that within 120 min of pneumoperitoneum in the three groups.The urine volume within 120 min of pneumoperitoneum and after 120 min of surgery in the group A was more than that in the group B and C(P<0.05).Conclusion Compared with 0.4μg/(kg·h)dexmedetomidine,preoperatively application of 0.8μg/(kg·h)dexmedetomidine for intravenous drip can alleviate perioperative pain more in elderly gynecological patients with malignant tumors,and improve their cognitive function.However,effects of 0.4μg/(kg·h)dexmedetomidine are fewer on renal function of the patients.