不同负荷剂量右美托咪定联合酮咯酸氨丁三醇对胸腔镜肺癌根治术后患者疼痛和认知功能的影响

Effects of Different Loading Doses of Dexmedetomidine Combined with Ketorolac Tromethamine on Pain and Cognitive Function in Patients after Thoracoscopic Radical Resection of Lung Cancer

【目的】探讨不同负荷剂量右美托咪定联合酮咯酸氨丁三醇对胸腔镜肺癌根治术后患者疼痛和认知功能的影响。【方法】选取2019年5月至2021年11月本院接受胸腔镜肺癌根治术患者81例,按照随机数表法分为A、B、C三组,每组27例。A组麻醉诱导前静脉注射酮咯酸氨丁三醇0.5 mg/kg,B组在A组基础上加用右美托咪定0.5μg/kg,C组在A组基础上加用右美托咪定1μg/kg。比较三组麻醉时间、手术时间、术中失血量、术中补液量、镇痛泵按压次数、术后舒芬太尼用量;术后即刻(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))患者疼痛视觉模评分(VAS)、简易智能精神状态检查量表(MMSE)评分。统计患者手术期间不良反应发生情况。【结果】三组患者麻醉时间、手术时间、术中失血量、术中补液量比较,差异均无统计学意义(P>0.05)。C组镇痛泵按压次数、术后舒芬太尼用量少于A组、B组,且B组少于A组,差异具有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4)各时间点三组VAS评分均呈现先升高后降低趋势,且C组VAS评分均低于A组、B组,B组低于A组,差异具有统计学意义(P<0.05)。各时间点三组MMSE评分均呈逐渐升高趋势,C组MMSE评分均低于A组、B组,且T_(1)、T_(2)时间点B组MMSE评分低于A组(P<0.05),但T_(3)、T_(4)时间点A组、B组MMSE评分比较,差异无统计学意义(P>0.05)。A、B两组患者不良反应发生率比较,差异无统计学意义(P>0.05),但C组不良反应发生率高于A组和B组(P<0.05)。【结论】右美托咪定联合酮咯酸氨丁三醇应用于胸腔镜肺癌根治术能减轻患者疼痛程度,减少其他麻醉药物用量,且右美托咪定负荷剂量为1μg/kg时疼痛程度更轻,但0.5μg/kg的负荷剂量有助于认知功能的恢复,不良反应更少,临床应根据实际需要进行选择。

【Objective】To investigate the effects of different loading doses of dexmedetomidine combined with ketorolac tromethamine on pain and cognitive function in patients after thoracoscopic radical resection of lung cancer.【Methods】A total of 81 patients who underwent thoracoscopic radical resection of lung cancer in our hospital from May 2019 to November 2021 were randomly divided into groups A,B and C,with 27 cases in each group.Group A was given ketorolac tromethamine 0.5 mg/kg intravenously before anesthesia induction,and group B was given dexmedetomidine 0.5μg/kg on the basis of group A,group C added dexmedetomidine 1μg/kg on the basis of group A.The anesthesia time,operation time,intraoperative blood loss,intraoperative rehydration,compression times of analgesic pump and postoperative sufentanil dosage were compared among the three groups;Immediately after operation(T_(1)),6 h(T_(2)),12 h(T_(3))and 24 h(T_(4)),the patients&apos;visual pain scale(VAS)and mini mental state examination scale(MMSE)scores were also compared.The incidence of adverse reactions during operation was counted.【Results】There was no significant difference in anesthesia time,operation time,intraoperative blood loss and intraoperative rehydration among the three groups(P>0.05).The pressing times of analgesic pump and the dosage of sufentanil after operation in the group C were less than those in the group A and the group B,and the group B was less than that in the group A,the difference was statistically significant(P<0.05).At each time point of T_(1),T_(2),T_(3) and T_(4),the VAS scores of the three groups increased first and then decreased,and the VAS scores of the group C were lower than those of the group A and the group B,and that of the group B was lower than that of the group A(P<0.05).The MMSE scores of the three groups at each time point showed a gradual upward trend.The MMSE scores of the group C were lower than those of the group A and the group B,and the MMSE scores of the group B at T_(1) and T_(2) time points were lower than those of the group A(P<0.05),but there was no significant difference between the group A and the group B at T_(3) and T_(4) time points(P>0.05).There was no significant difference in the incidence of adverse reactions between the group A and the group B(P>0.05),but the incidence of adverse reactions in the group C was higher than that in the group A and the group B(P<0.05).【Conclusion】Dexmedetomidine combined with ketorolac tromethamine in thoracoscopic radical resection of lung cancer can reduce the degree of pain and the dosage of other anesthetics;when the loading dose of dexmedetomidine is at 1μg/kg,the degree of pain was lighter,but the loading dose of 0.5μg/kg is conducive to the recovery of cognitive function and less adverse reactions.It should be selected according to the actual needs.