右美托咪定联合地佐辛对胸腔镜肺癌根治术老年患者血流动力学及术后苏醒质量的影响

Effects of dexmedetomidine combined with dezocine on hemodynamics and postoperative recovery quality in elderly patients undergoing radical thoracoscopy for lung cancer

目的:探讨右美托咪定联合地佐辛对胸腔镜肺癌根治术老年患者血流动力学和术后苏醒质量的影响。方法:将接受全身麻醉下胸腔镜肺癌根治手术的180例老年患者,随机平均分为右美托咪定联合地佐辛组(DZ组)、右美托咪定组(D组)、地佐辛组(Z组)及对照组(C组),比较4组麻醉围术期平均动脉压(MAP)的变化、苏醒时间、拔管时间及疼痛VAS评分、术前术后重复性成套神经心理状态测验(RBANS)评分及苏醒期不良反应的发生情况。结果:DZ组在插管后、关胸后及拔管后的MAP、术后VAS评分、谵妄及寒颤发生比例均低于C组;术后1 d,DZ组和D组的MMSE评分优于Z组和C组;术后7 d DZ组RBANS评分优于其他3组(P<0.05)。结论:在治疗接受胸腔镜肺癌根治手术治疗的老年患者中,右美托咪定联合地佐辛可有效维持血流动力学稳定,并改善术后苏醒质量。

Objective:To investigate the effect of dexmedetomidine combined with dezocine on hemodynamics and postoperative recovery quality in elderly patients undergoing radical thoracoscopy for lung cancer.Methods:One hundred and eighty elderly patients undergoing radical thoracoscopic lung cancer surgery under general anesthesia were randomly and equally divided into group DZ(treated with dexmedetomidine combined with dezocine),group D(treated with only dexmedetomidine),group Z(treated with only dezocine)and group C(control).The changes in mean arterial pressure(MAP),wake-up and extubation time and visual analogue scale(VAS)scores,pre-and post-operative scores of the repeatable battery for the assessment of neuropsychological status(RBANS)and the incidence of adverse reactions during the awake-up were compared in the four groups during the perioperative period.Results:The MAP after intubation,chest closure and extubation,postoperative VAS scores,and the proportion of delirium and chills occurrence were lower in the group DZ than the group C;the MMSE scores were better in the group DZ and D than the group Z and C at the first day after surgery;the RBANS scores were better in the group DZ than the other three groups 7 d after surgery(P<0.05).Conclusion:Dexmedetomidine combined with dezocine for the treatment of elderly patients undergoing thoracoscopic radical lung cancer surgery can effectively maintain hemodynamic stability and improve the quality of postoperative recovery.