右美托咪定不同配伍镇痛对腹腔镜结直肠癌手术ASAⅢ级患者术后谵妄与胆碱酯酶的影响

Effect of analgesia of dexmedetomidine combined with different drugs on postoperative delirium and cholinesterase in patients with ASA gradeⅢundergoing laparoscopic colorectal cancer surgery

目的:探讨右美托咪定配伍舒芬太尼或地佐辛或布托啡诺静脉镇痛对腹腔镜结直肠癌手术ASAⅢ级结直肠癌患者术后谵妄(POD)及胆碱酯酶的影响。方法:共240例腹腔镜结直肠癌手术患者纳入此项前瞻、随机、双盲、对照研究。按随机数表法分为S组(舒芬太尼组)、D组(地佐辛组)与B组(布托啡诺组),每组80例,行复合右美托咪定静脉镇痛。利用护理谵妄筛查量表筛选术后第1天、第2天、第3天POD发生情况,并检测术前及术后第1天、第3天血清胆碱酯酶活性。结果:POD总体发生率为13.79%,3组间POD发生率差异无统计学意义(P>0.05),POD患者术前血清胆碱酯酶活性略低于正常值,术后有增高趋势,POD组内、与非POD患者组间相比差异均有统计学意义(P<0.05),其他观察指标差异无统计学意义(P>0.05)。结论:右美托咪定伍用舒芬太尼或地佐辛、布托啡诺静脉镇痛的腹腔镜结直肠癌术后POD发生率仍高,血清胆碱酯酶活性可部分预测POD的发生。

Objective:To evaluate the effects of intravenous analgesia of dexmedetomidine combined with sufentanil or dezocine or butorphanol on postoperative delirium(POD)and serum cholinesterase of ASAⅢpatients undergoing laparoscopic surgery of colorectal cancer.Methods:Total 240 ASAⅢpatients undergoing laparoscopic surgery of colorectal cancer were included in the prospective,randomized,double-blind,controlled study and randomly divided into Group S(sufentanil)or Group D(dezocine)or Group B(butorphanol)according to the random table method,with 80 cases in each group and intravenous analgesia with dexmedetomidine.POD screening was conducted at the first,the second and the third day after operation using a validated screening tool.The activities of serum cholinesterase were detected before operation,also at the first day and the third day postoperatively.Results:The total incidence of POD was 13.79%,with no significant difference among the three groups.The activities of serum cholinesterase were a little lower in POD patients than those without POD,but there was an elevated trend after operation,there were significant differences between-subjects effects and within-subjects effects(P<0.05).There were no significant differences in other observed indexes.Conclusions:The incidence of POD is still higher in ASAⅢpatients who are given dexmedetomidine intravenous analgesia combined with sufentanil,dezocine or butorphanol after laparoscopic surgery of colorectal cancer.The activity of serum cholinesterase may predict the development of POD.