不同剂量右美托咪定对后腹腔镜下肾囊肿去顶术后应激及认知功能的影响研究

Effects of different doses of dexmedetomidine on stress and cognitive function after retroperitoneal laparoscopic unroofing of renal cysts

目的:研究不同剂量右美托咪定对后腹腔镜下肾囊肿去顶术后应激及认知功能的影响。方法:选取2018年1月至2019年6月于我院泌尿外科择期行后腹腔镜肾囊肿去顶术患者共90例,根据随机数字法将其分为高剂量组(0.8μg/kg)、低剂量组(0.4μg/kg)及对照组。比较三组患者治疗过程中不良反应发生情况、手术情况、术前1 d、术后1 d及术后3 d的血清S-100β蛋白、神经元特异性烯醇化酶(NSE)、超敏C反应蛋白(hs-CRP)、白细胞介素(IL-6)的水平及认知功能。结果:低剂量组及对照组患者的苏醒时间及拔管时间明显优于高剂量组,差异有统计学意义(P<0.05);麻醉10 min后Ramsay镇静评分高剂量组及低剂量组优于对照组,差异有统计学意义(P<0.05);三组患者不良反应及并发症发生率差异无统计学意义(P>0.05);高剂量组及低剂量组在术后1 d及术后3 d的血清数据比较中优于对照组,且低剂量组优于高剂量组,差异均有统计学意义(P<0.05);三组患者的认知功能评分中,高剂量组及低剂量组在术后1 d的评分结果优于对照组,差异均有统计学意义(P<0.05)。结论:腹腔镜肾囊肿去顶术中,0.4μg/(kg·h)的负荷剂量速度持续静脉泵入右美托咪定更能降低患者术后应激,减轻术后认知功能的损伤。

Objective:To study the effects of different doses of dexmedetomidine on stress and cognitive function after retroperitoneal laparoscopic unroofing of renal cysts.Methods:120 patients with retroperitoneal laparoscopic renal cyst unroofing from January 2018 to June 2019 were selected.They were divided into high dose group(0.8μg/kg),low dose group(0.4μg/kg)and control group.The levels of serum S-100βprotein,neuron-specific enolase(NSE),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and cognitive function were compared among the three groups.Results:The recovery time and extubation time of the low-dose group and the control group were better than those of the high-dose group,and difference were statistically significant(P<0.05).Ramsay sedation score of the high-dose group and the low-dose group was better than that of the control group after 10 minutes of anesthesia(P<0.05).The adverse reactions of the three groups were no significant(P>0.05).The high-dose group and low-dose group were better than the control group in the comparison of serum data 1 day and 3 days after operation,and the low-dose group was better than the high-dose group,and the difference was statistically significant(P<0.05).In the cognitive function scores of the three groups,the high-dose group and the low-dose group were better than the control group at 1 day after operation(P<0.05).Conclusion:During laparoscopic unroofing of renal cysts,continuous infusion of dexmedetomidine at a loading dose of 0.4μg/(kg·h)can reduce the postoperative stress and cognitive impairment.