右美托咪定对老年前列腺电切术全麻患者导管相关膀胱刺激征和认知功能的影响

The effect of dexmedetomidine on catheter-related bladder irritation and cognitive dysfunction in elderly patients undergoing general anesthesia for electrosurgical prostatectomy

目的探讨右美托咪定对老年前列腺电切术全麻患者导管相关膀胱刺激征和认知功能的影响。方法纳入2018年10月至2020年10月在本院行老年前列腺电切术患者100例,以随机数字法均分成两组,各50例。对照组在麻醉诱导前输注氯化钠,观察组输注右美托咪定,比较两组不同时点HR、MAP及SpO_(2)水平,S100β水平,MMSE评分,认知功能障碍情况,导管相关膀胱刺激征发生率及麻醉情况。结果两组T0时刻HR、MAP及SpO2比较差异无统计学意义(P>0.05),T1、T2时刻观察组上述指标均优于对照组,且两组与同组T0时刻比较差异均有统计学意义(P<0.05)。两组术前MMSE与S100β比较均无统计学差异(P>0.05),术后观察组上述指标均优于对照组(P<0.05)。除观察组术前术后S100β水平比较无统计学差异外,两组其他指标与术前相比均有统计学差异(P<0.05)。观察组认知功能障碍发生率为4.0%,导管相关膀胱刺激征为36.0%,比对照组明显更低,差异有统计学意义(P<0.05)。两组自主呼吸恢复时间与睁眼时间比较差异无统计学意义(P>0.05),但观察组丙泊酚与瑞芬太尼使用剂量均明显少于对照组,差异有统计学意义(P<0.05)。结论老年前列腺电切术全麻诱导前给予右美托咪定可减轻导管相关膀胱刺激征,保持血流动力学处于稳定状态,有利于改善术后近期认知功能障碍。

Objective To investigate the clinical effect of dexmedetomidine on catheter-related bladder irritation and cognitive dysfunction in elderly patients undergoing general anesthesia under trans prostatectomy.Methods A total of 100 elderly patients undergoing electrosurgical resection of the prostate from October 2018 to October 2020 were enrolled.They were divided into two groups with 50 cases in each group by random numbers.The control group received sodium chloride before induction of anesthesia and the observation group received infusion With dexmedetomidine,the HR,MAP and SpO_(2) levels,S100βlevels,MMSE scores,cognitive dysfunction and the incidence of catheter-related bladder irritation and anesthesia were compared between the two groups at different time points.Results There was no statistically significant difference in HR,MAP and SpO_(2) between the two groups at T0(P>0.05),while the above indicators in the observation group at T1 and T2 were better than those in the control group,and the two groups had statistics compared with the same group at T0 Significance(P<0.05).Postoperative observation group MMSE and S100βare better than control group(P<0.05).The incidence of cognitive dysfunction in observation group is 4.0%,and catheter-related bladder irritation is 36.0%,which is higher than the control group 18.0%and 56.0%were significantly lower,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the spontaneous breathing recovery time and eye-opening time between the two groups(P>0.05),but the observation group Propofol and the dosage of Fentanyl was significantly less than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The administration of dexmedetomidine before induction of general anesthesia in elderly prostatectomy can reduce catheter-related bladder irritation,keep hemodynamics in a stable state,and improve short-term cognitive dysfunction after surgery.