右美托咪定不同给药方式联合硬膜外麻醉对胃癌患者术后认知功能及血清炎性因子的影响

Effects of dexmedetomidine combined with epidural anesthesia on the cognitive function and serum inflammatory factors in patients with gastric cancer after operation

目的探讨右美托咪定不同给药方式联合硬膜外麻醉对胃癌患者术后认知功能及血清炎性因子的影响。方法选取2018年9月至2019年9月收治的老年结直肠癌根治术患者92例,按照随机数字表法分为观察组和对照组,每组46例。观察组在硬膜外阻滞中给予右美托咪定,并在硬膜外镇痛泵中给予追加剂量。对照组患者麻醉诱导前静脉给予负荷量,并在硬膜外镇痛泵中给予追加剂量。观察2组患者手术前后血流动力学参数(HR、MAP、SpO2),苏醒期恢复情况(自主呼吸恢复时间、睁眼时间以及拔管时间),术后视觉模拟评分(VAS评分),手术前后简易智力状态检查量表(MMSE)及血清γ-谷氨酰转肽酶(γ-GGT)、白介素-6(IL-6)水平。结果2组患者HR、MAP水平显著低于术前(P<0.05),拔管时2组患者HR及MAP显著高于术毕(P<0.05),拔管后30 min观察组MAP显著高于对照组(P<0.05);观察组自主呼吸恢复时间、睁眼时间以及拔管时间均明显低于对照组(P<0.05);2组患者术后VAS评分差异明显(P<0.05),术后1 d、3 d 2组患者患者VAS评分较术后6 h明显降低,观察组患者术后1 d、3 d VAS评分显著低于对照组(P<0.05);观察组术后4 h、24 h MMSE评分显著高于对照组(P<0.05);观察组患者术后48 hγ-GGT水平显著低于对照组(P<0.05)。观察组患者48 h IL-6浓度显著低于对照组(P<0.05)。结论右美托咪定诱导前硬膜外给药相对于静脉给药更能有助于围术期血流动力学的稳定,改善老年胃癌患者术后认知功能障碍的发生情况,并降低患者术后血清γ-GGT、IL-6等炎性因子水平,值得临床推广。

Objective To investigate the effects of dexmedetomidine by different medication ways combined with epidural anesthesia on the cognitive function and serum inflammatory factors in patients with gastric cancer after operation.Methods A total of 92 elderly patients with colorectal cancer who were treated by radical resection of rectal carcinoma in our hospital from September 2018 to September 2019 were enrolled in the study,who were randomly divided into observation group and control group,with 46 cases in each group.The patients in observation group were given dexmedetomidine in epidural block and additional dose in epidural analgesia pump,however,the patients in control group were given loading dose intravenously before anesthesia induction and additional dose in epidural analgesia pump.The general information,hemodynamic parameters(HR,MAP,SpO2)before and after operation,recovery status at recovery period(spontaneous breathing recovery time,eye opening time and extubation time),and postoperative visual analogue scale(VAS score),Mini Mental State Examination(MMSE)before and after operation,and serum levels of gamma glutamyl transpeptidase(gamma GGT)and interleukin-6(IL-6)were observed and compared between the two groups.Results After operation the levels of HR and MAP in both groups were significantly decreased(P<0.05),which in extubation were significantly higher than those at the end of operation(P<0.05),moreover,the MAP levels at 30min after extubation in observation group were significantly higher than those in control group(P<0.05).Moreover the recovery time of spontaneous breathing,eye opening time and extubation time in observation group were significantly shorter than those in control group(P<0.05).The VAS scores at 1d,3d were significantly lower than those at 6h after operation,which in observation group were significantly lower than those in control group(P<0.05).In addition the MMSE scores at 4h,24h after operation in observation group were significantly higher than those in control group(P<0.05),however,the levels ofγ-GGT and IL-6 at 48h after operation in observation group were significantly lower than those in control group(P<0.05).Conclusion The epidural administration of dexmedetomidine before induction is helpful to stabilize perioperative hemodynamics,improve postoperative cognitive dysfunction in elderly patients with gastric cancer,and reduce the serum levels of inflammatory factors includingγ-GGT and IL-6,which is worthy of clinical promotion.