右美托咪定对大隐静脉曲张患者血流动力学、应激反应及认知功能的影响

Effect of dexmedetomidine on hemodynamics,postoperative stress response and cognitive function in patients with varicosis of great saphenous vein

目的探讨右美托咪定对大隐静脉(GSV)曲张患者血流动力学、应激反应及认知功能的影响。方法收集2020年1月至2022年1月北京积水潭医院收治的89例GSV曲张患者的临床资料,根据手术麻醉方案的不同将其分为右美托咪定复合瑞芬太尼(DR)组(n=47)和咪达唑仑复合瑞芬太尼(MR)组(n=42)。比较两组患者术后的临床指标[手术时间、麻醉恢复时间、苏醒期镇静-躁动评分(SAS)、瑞芬太尼用量]。分别于麻醉前(T_(1))、术中10 min(T_(2))、术中30 min(T_(3))、术毕即刻(T_(4))观察两组患者的血流动力学指标[心率(HR)、平均动脉压(MAP)]、生命体征[血氧饱和度(SpO_(2))、呼吸频率(RR)与Ramsay镇静评分(RSS)]。术后2、12、24 h比较两组患者视觉模拟评分法(VAS)评分、简易精神状态量表(MMSE)评分。比较两组患者手术前后应激反应指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、丙二醛(MDA)、超氧化物歧化酶(SOD)],统计两组患者术后不良反应发生情况。结果DR组患者麻醉恢复时间、SAS评分、瑞芬太尼用量均低于MR组患者,差异均有统计学意义(P<0.05)。T_(2)、T_(3)、T_(4)时,DR组患者HR、SpO_(2)、RR均高于MR组患者,MAP、RSS均低于MR组患者,差异均有统计学意义(P<0.05)。术后12、24、48 h,DR组患者VAS评分均低于MR组患者;术后12、24 h,DR组患者MMSE评分均高于MR组患者,差异均有统计学意义(P<0.05)。术后48 h,两组患者MMSE评分比较,差异无统计学意义(P>0.05)。术后,两组患者CRP、IL-6、MDA水平均高于本组术前,SOD水平均低于本组术前,但DR组患者CRP、IL-6、MDA水平均低于MR组患者,SOD水平高于MR组患者,差异均有统计学意义(P<0.05)。DR组患者不良反应总发生率为2.13%,低于MR组患者的16.67%,差异有统计学意义(P<0.05)。结论右美托咪定可较好地维持GSV曲张患者术中血流动力学与生命指征的稳定性,减轻患者术后应激反应程度,改善患者的认知功能,降低不良反应发生率,值得临床推广。

Objective To investigate the effect of dexmedetomidine on hemodynamics,postoperative stress response and cognitive function in patients with varicosis of great saphenous vein(GSV).Method The data of 89 GSV patients admitted in Beijing Jishuitan Hospital from January 2020 to January 2022 were collected.According to the surgical anesthesia plan,the patients were divided into dexmedetomidine remifentanil(DR)group(n=47)and the midazolam remifentanil(MR)group(n=42).Postoperative clinical indicators of patients in the two groups were compared,including operation time,anesthesia recovery time,sedation-agitation scale(SAS)during recovery and dosage of remifentanil.Hemodynamic indicators of heart rate(HR),mean arterial pressure(MAP),vital signs of blood oxygen saturation(SpO_(2)),respiratory rate(RR)and Ramsay sedation score(RSS)of patients in the two groups were observed before anesthesia(T_(1)),10 minutes during surgy(T_(2)),30 minutes during surgy(T_(3))and immediately after operation(T_(4)).Visual analogue scale(VAS)score and mini-mental state examination(MMSE)of two groups were observed 2,12 and 24 h after surgery.Preoperative and postoperative stress response indexes of C-reactive protein(CRP),interleukin-6(IL-6),malondialdehyde(MDA)and superoxide dismutase(SOD)of two groups were observed.The incidence of postoperative adverse reactions was analyzed.Result The anesthesia recovery time,SAS score and remifentanil dosage in DR group were lower than those in MR group,the differences were statistically significant(P<0.05).At T_(2),T_(3)and T_(4),HR,SpO_(2)and RR in DR group were higher than those in MR group,MAP and RSS were lower than those in DR group,the differences were statistically significant(P<0.05).VAS score of DR group was lower than that of MR group at 12,24 and 48 h postoperatively,MMSE score higher than that of MR group at 12 and 24 h postoperatively,the differences were statistically significant(P<0.05).There was no significant difference in MMSE score between the two groups 48 h after surgery(P>0.05).After surgy,CRP,IL-6 and MDA in two groups were higher than those before operation in the same group,SOD was lower than that before surgy in the same group;CRP,IL-6 and MDA in DR group were lower than those in MR group,SOD higher than that in MR group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in DR group was 2.13%,lower than that in MR group with 16.67%,the difference was statistically significant(P<0.05).Conclusion Dexmedetomidine can maintain the stability of intraoperative hemodynamics and vital signs during surgery in varicosis of GSV patients,improve patients’cognitive function and reduce the incidence of adverse reactions,which is worthy of promotion clinically.