丙泊酚联合右美托咪定对腹腔镜胆囊切除手术患者的影响

Effects of Propofol Combined with Dexmedetomidine on Patients after Laparoscopic Cholecystectomy

目的:探究丙泊酚联合右美托咪定对腹腔镜胆囊切除手术患者的影响。方法:从2018年12月-2020年12月中国人民解放军联勤保障部队第九〇七医院接受行腹腔镜胆囊切除手术的患者中随机选取138例,采用随机数字表法分为观察组和对照组各69例。对照组予以丙泊酚麻醉维持,观察组予以丙泊酚联合右美托咪定麻醉维持。记录两组患者手术状况,包括睁眼时间、拔管时间、定向能力恢复耗时、自主呼吸恢复耗时、镇静药补充量;记录苏醒即刻、苏醒1 h和苏醒3 h时两组患者躁动状况[重症监护室常用镇静评分(Ramsay评分)、Riker镇静-躁动评分(SAS)];记录术后6 h、术后12 h、术后1 d时两组患者认知功能状况[简易精神状态量表(MMSE量表)];比较手术前和术后1 d时,两组血清相关指标,包括血清S-100β蛋白(S-100β)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平;记录术后3 d期间,两组并发症发生状况,包括心动过缓、高血压、呼吸抑制、感染。结果:两组患者睁眼时间、拔管时间比较,差异无统计学意义(P>0.05),观察组定向能力恢复耗时、自主呼吸恢复耗时、镇静药补充量均优于对照组(P<0.05)。苏醒即刻、苏醒1 h时,观察组Ramsay评分均高于对照组,SAS均低于对照组(P<0.05),苏醒3 h时,两组患者Ramsay评分、SAS比较,差异无统计学意义(P>0.05)。术后6 h、术后12 h、术后1 d时,观察组MMSE评分均高于对照组(P<0.05)。术后1 d两组患者血清S-100β、SOD、MDA水平较手术前均有上升,且观察组低于对照组(P<0.05)。术后3 d内,观察组并发症总发生率低于对照组(P<0.05)。结论:丙泊酚联合右美托咪定能够改善腹腔镜胆囊切除术手术质量,改善患者术后苏醒期躁动(EA)状况,加快认知功能恢复,减少对认知功能损伤,具有安全性,值得临床推广。

Objective:To investigate the effects of Propofol combined with Dexmedetomidine on patients undergoing laparoscopic cholecystectomy(LC).Method:A total of 138 patients who underwent laparoscopic cholecystectomy in the 907 Hospital of PLA Joint Logistic Support Force from December 2018 to December 2020 were randomly selected and divided into observation group and control group with 69 cases in each group by random number table method.The control group was given Propofol anesthesia to maintain,the observation group was given Propofol combined with Dexmedetomidine anesthesia to maintain.The operation status of the two groups were recorded,including the time of opening eyes,the time of extubation,the time of recovery of orientation,the time of recovery of spontaneous breathing and the dosage of sedatives.The agitation status[Ramsay sedation score commonly used in intensive care unit(Ramsay score)and Riker sedation agitation score(SAS)]of the patients in the two groups were recorded immediately after awakening,1 h after awakening and 3 h after awakening.The cognitive function before operation,6 h after operation,12 h after operation and 1 d after operation were recorded with mini mental state examination(MMSE).The serum related indexes[the levels of serum S-100βprotein(S-100β),superoxide dismutase(SOD)and malondialdehyde(MDA)]of the two groups were compared before operation and 1 day after operation.The adverse reactions of the two groups during the 3 days after operation were recorded,including bradycardia,hypertension,respiratory depression and infection.Result:There were no significant differences in the time of opening eyes and extubation time between the two groups(P>0.05).The recovery time of orientation,spontaneous breathing time and dosage of sedative supplement in the observation group were better than those in the control group(P<0.05).The Ramsay score of the observation group was higher than that of the control group immediately after awakening and 1 h after awakening,and the SAS score of the observation group was lower than that of the control group(P<0.05).There were no significant differences in Ramsay score and SAS score between the two groups at 3 hours after awakening(P>0.05).The MMSE scores of the observation group were higher than those of the control group at 6 h,12 h and 1 d postoperatively(P<0.05).The serum levels of S-100β,SOD and MDA 1 day after operation in the two groups were higher than those before operation,and the levels in the observation group were lower than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group within 3 days after operation(P<0.05).Conclusion:Propofol combined with Dexmedetomidine can improve the quality of laparoscopic cholecystectomy surgery,improve the postoperative EA status of patients,speed up the recovery of cognitive function,reduce the impairment of cognitive function,which is safe and worthy of clinical promotion.