右美托咪定复合舒芬太尼麻醉在老年肝癌患者肝切除术中的应用效果观察

Observation on effect of dexmedetomidine combined with sufentanil on elderly patients with liver cancer undergoing hepatectomy

目的探讨右美托咪定复合舒芬太尼麻醉在老年肝癌患者肝切除术中的应用效果。方法抽取2020年6月至2021年6月三门峡市中心医院收治的64例老年肝癌患者, 按随机数字表法分为观察组与对照组, 每组32例。所有患者均行肝切除术治疗, 对照组采取常规麻醉(丙泊酚+瑞芬太尼+顺式阿曲库铵), 观察组采取右美托咪定+舒芬太尼麻醉。比较两组患者术中不同时点(麻醉前、麻醉10 min、麻醉30 min、术毕时)血流动力学、治疗期间不良反应(一过性高血压、低血压、心动过缓)、术后认知功能障碍(POCD)发生情况。结果麻醉10 min时、麻醉30 min时较麻醉前心率(HR)、平均动脉压(MAP)逐渐降低, 术毕时, 两组MAP、HR较麻醉30 min时升高, 且观察组麻醉10 min、麻醉30 min、术毕HR、MAP高于对照组, 两组MAP、HR水平组间时点、组间时点交互比较, P<0.05。观察组术后心动过缓、POCD发生率低于对照组(P<0.05)。结论右美托咪定复合舒芬太尼能够有效稳定老年肝癌患者术中血流动力学, 降低术后POCD发生率, 安全性较高。

Objective To investigate the effect of dexmedetomidine combined with sufentanil anesthesia in hepatectomy in elderly patients with liver cancer.Methods A total of 64 elderly patients with liver cancer treated in Sanmenxia Central Hospital from June 2020 to June 2021 were selected,they were divided into observation group and control group by random number table method,with 32 cases in each group.All patients underwent hepatectomy,the control group was given routine anesthesia(propofol+remifentanil+cisatracurium),the observation group was given dexmedetomidine+sufentanil anesthesia.The hemodynamics,adverse reactions(transient hypertension,hypotension,bradycardia)and postoperative cognitive dysfunction(POCD)were compared between the two groups at different time points(before anesthesia,10 min of anesthesia,30 min of anesthesia and after operation).Results Heart rate(HR)and mean arterial pressure(MAP)were decreased gradually 10 min and 30 min after anesthesia than those before anesthesia,at the end of the operation,MAP and HR of both groups were increased than those 30 minutes after anesthesia,and MAP and HR in the observation group were higher than those in the control group at 10 min,30 min after anesthesia and the end of operation,comparision of MAP and HR levels of both groups among groups,time points and interaction between groups and time points,P<0.05.The incidence of bradycardia and POCD in the observation group was lower than that in the control group(P<0.05).Conclusions Dexmedetomidine combined with sufentanil can effectively stabilize the intraoperative hemodynamics of elderly patients with liver cancer,reduce the incidence of POCD after operation,with high safety.