小剂量瑞芬太尼泵注在老年胸腔镜肺癌根治术术后中的应用效果观察

Effect of low-dose Remifentanil pump infusion on delirium after thoracoscopic radical resection of lung cancer in elderly patients

目的:观察小剂量瑞芬太尼[0.05μg/(kg·min)]泵注在老年胸腔镜肺癌根治术术后的应用效果。方法:选取2021年1月—6月山东第一医科大学第二附属医院全麻下实施胸腔镜辅助肺癌根治术治疗的60例患者,采用随机数字表法将患者分为A组与B组各30例。A组在术后的麻醉苏醒期微量泵注瑞芬太尼[0.05μg/(kg·min)];B组在术后的麻醉苏醒期注射等体积0.9%氯化钠溶液。观察两组患者恢复自主呼吸时间、气管拔出时间、PA C U停留时间;患者镇静-躁动评分(SAS);患者在术后1、2、3 d发生谵妄的情况。结果:A组和B组的恢复自主呼吸时间、气管拔除插管时间比较,差异无统计学意义(P>0.05)。A组P A C U停留时间短于B组,A组患者镇静-躁动评分明显低于B组,A组患者术后第1~2天的POD发生率低于B组,差异有统计学意义(P<0.05)。结论:术后给予老年胸腔镜肺癌根治术患者泵注小剂量瑞芬太尼[0.05μg/(kg·min)],不会延长拔管时间及患者PACU滞留时间,而且还能够提高苏醒质量,降低患者POD的发生率,值得临床应用。

Objective To investigate the effect of low-dose Remifentanil(0.05μg/kg·min)pump on delirium after radical thoracoscopic lung cancer resection in elderly patients.Methods From January to June 2021,60 patients who underwent thoracoscopic adjuvant radical resection of lung cancer under general anesthesia in the Second Affiliated Hospital of Shandong First Medical University were selected as the study subjects,and the patients were divided into group A and group B by random number table method,and 30 patients were divided into group A and group B.Group A was the remifentanil group,and the micropump of remifentanil(0.05μg/kg·min)during the awakening period of anesthesia;Group B is the normal saline group,which injects an equal volume of normal saline.The recovery time of spontaneous breathing,tracheal extraction time,and PACU residence time of the two groups were observed.Patient sedation-agitation score(SAS);Patients develop delirium 1 to 2 and 3 days after surgery.Results There was no significant difference between A group and B group in the time to regain spontaneous breathing and the time to endotracheal extubation(P>0.05).The residence time of PACU in the A group was shorter than that in the B group,the sedation-agitation score of patients in the A group was significantly lower than that in the B group,and the incidence of POD on the first and second days after surgery in the A group decreased significantly,and the differences were statistically significant(P<0.05).Conclusion Postoperative administration of low-dose remifentanil 0.05μg/kg·min to elderly patients undergoing radical thoracoscopic lung cancer resection will not prolong the extubation time and the residence time of PACU,which can improve the quality of awakening and reduce the risk of POD in patients,which is worthy of clinical promotion and application.