右美托咪定复合亚麻醉剂量氯胺酮在老年结肠癌患者术中的应用

Application of Dexmedetomidine Combined with Subanaesthetic Dose of Ketamine in Elderly Patients with Colon Cancer During Operation

目的探讨右美托咪定复合亚麻醉剂量氯胺酮在老年结肠癌患者术中的应用效果。方法选取2018年2月至2020年2月濮阳市人民医院收治的78例老年结肠癌患者作为研究对象,根据麻醉方案分为对照组与联合组,各39例。两组患者均于静脉麻醉复合硬脊膜外阻滞下实施结肠癌根治手术,对照组接受右美托咪定进行麻醉处理,联合组接受右美托咪定复合亚麻醉剂量氯胺酮进行麻醉处理。比较两组智力状况评分、炎症因子水平、拔管时间、完全清醒时间、恢复自主呼吸时间以及苏醒评分。结果两组智力状况评分存在时间、组间、组间和时间交互效应(P<0.05),术前、术后第3天,两组智力状况评分比较,差异无统计学意义(P>0.05),术后第1、2天,联合组智力状况评分均高于对照组(P<0.05)。术后,两组超敏C反应蛋白、白细胞介素-17、肿瘤坏死因子-α水平均升高,联合组各指标水平均低于对照组(P<0.05)。两组完全清醒时间、拔管时间、苏醒评分、恢复自主呼吸时间比较,差异无统计学意义(P>0.05)。结论右美托咪定复合亚麻醉剂量氯胺酮对老年结肠癌患者认知功能影响较小,术后炎症因子水平相对较低,且不会对其苏醒质量造成影响。

Objective To investigate the effect of dexmedetomidine combined with subanaesthetic dose of ketamine in elderly patients with colon cancer during operation.Methods A total of 78 elderly patients with colon cancer from Puyang People’s Hospital from February 2018 to February 2020 were selected,and they were divided into control group and combined group according to the anesthesia plan,with 39 cases in each group.Patients in the two groups underwent radical surgery for colon cancer under intravenous anesthesia combined with epidural block.Control group was treated with dexmedetomidine for anesthesia,and combined group was treated with dexmedetomidine combined with subanaesthetic dose of ketamine for anesthesia.The intelligence score,inflammatory factor level,extubation time,complete wakefulness time,time to return to spontaneous breathing and recovery score were compared between the two groups.Results There were time effect,intergroup effect,intergroup and time interaction effect in the intelligence score of the two groups(P<0.05).There were no statistical differences in intelligence scores between the two groups before and on the third day after operation(P>0.05).On the first and second day after operation,the intelligence scores of combined group were higher than those of control group(P<0.05).After operation,the levels of high sensitivity C-reactive protein,interleukin-17 and tumor necrosis factor-αincreased in the two groups,while the levels of each index in combined group were all lower than those in control group(P<0.05).There were no statistical differences in complete awake time,extubation time,recovery score and time to return to spontaneous breathing between the two groups(P>0.05).Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine has little effect on the cognitive function of elderly patients with colon cancer,and the levels of inflammatory factors are relatively low after operation,and it will not affect the quality of recovery.