右美托咪定对老年腹腔镜胆囊切除术患者麻醉效果及血流动力学的影响

Effects of Dexmedetomidine on Anesthesia and Hemodynamics in Elderly Patients Undergoing Laparoscopic Cholecystectomy

目的探讨右美托咪定对老年腹腔镜胆囊切除术患者麻醉效果及血流动力学的影响。方法便利选择2020年6月—2021年5月于菏泽市第二人民医院实施全麻下腹腔镜胆囊切除术的94例老年患者,以随机数字表法将其分为两组。对照组47例以丙泊酚维持麻醉,研究组47例以右美托咪定维持麻醉。比较两组患者不同麻醉时间点[麻醉前30 min(T0)、开始手术切皮时(T1)、切除胆囊时(T2)、完成手术时(T3)]的血流动力学指标[心率(HR)、平均动脉压(MAP)与脑电双频指数(BIS)]、手术时间、术后苏醒时间、麻醉前30 min与术后24 h时简易神经状况检查量表(MMSE)评分,以及麻醉相关不良反应情况。结果在T2与T3时间点,研究组HR(73.47±4.32)次/min、(74.05±3.00)次/min,MAP(90.03±3.54)mmHg、(91.52±3.47)mmHg较对照组(67.02±3.45)次/min、(70.52±2.70)次/min及(84.65±3.05)mmHg、(86.69±4.00)mmHg高,差异有统计学意义(t=7.998、5.996、7.893、6.253,P<0.05)。研究组手术时间(47.62±5.65)min、术后苏醒时间(15.65±5.03)min,与对照组(48.30±4.98)、(15.60±5.00)min对比,差异无统计学意义(t=0.619,0.048,P>0.05)。术后24 h时,研究组MMSE评分(28.65±0.60)分较对照组(27.00±0.45)分高,差异有统计学意义(t=15.082,P<0.05)。研究组麻醉相关不良反应发生率10.64%与对照组12.77%对比,差异无统计学意义(χ^(2)=0.103,P>0.05)。结论右美托咪定在老年腹腔镜胆囊切除术患者中具有显著的麻醉效果,可以有效维持血流动力学稳定性。

Objective To investigate the effect of dexmedetomidine on anesthesia and hemodynamics in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 94 elderly patients who underwent laparoscopic cholecystectomy under general anesthesia in Second People´s Hospital of Heze City from June 2020 to May 2021 were conveniently selected and divided into two groups by random number table method.47 patients in the control group were maintained anesthesia with propofol,and 47 patients in the study group were maintained anesthesia with dexmedetomidine.The hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)and bispectral index(BIS)],operation time,postoperative recovery time,mini neurological status examination(MMSE)scores at 30 min before anesthesia and 24 h after operation,and anesthesia-related adverse reactions were compared between the two groupsatdifferentanesthesiatimepoints[30minbeforeanesthesia(T0),atthebeginningofskinincision(T1),atthetime of gallbladder removal(T2),at the completion of the operation(T3)].Results At T2 and T3 time points,the HR was(73.47±4.32)times/min,(74.05±3.00)times/min,MAP(90.03±3.54)mmHg,(91.52±3.47)mmHg of the study group,which were significantly higher than those of the control group(67.02±3.45)times/min,(70.52±2.70)times/min,and(84.65±3.05)mmHg,(86.69±4.00)mmHg,the difference was statistically significant(t=7.998,5.996,7.893,6.253,P<0.05).The operation time(47.62±5.65)min and postoperative recovery time(15.65±5.03)min of the study group were compared with those of the control group(48.30±4.98)min and(15.60±5.00)min,and the difference was not statistically significant(t=0.619,0.048,P>0.05).At 24 h after operation,the MMSE score of the study group(28.65±0.60)points was higher than that of the control group(27.00±0.45)points,the difference was statistically significant(t=15.082,P<0.05).The incidence of anesthesia-related adverse reactions in the study group was 10.64%compared with 12.77%in the control group,and the difference was not statistically significant(χ^(2)=0.103,P>0.05).Conclusion Dexmedetomidine has a significant anesthetic effect in elderly patients with laparoscopic cholecystectomy,can effectively maintain hemodynamic stability.