老年胸腔镜肺癌根治术患者持续泵注右美托咪定复合羟考酮在麻醉重症监护室的恢复效果观察

Observation on the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone in anesthesia intensive care unit for elderly patients undergoing thoracoscopic radical resection of lung cancer

目的比较老年胸腔镜肺癌根治术后患者持续泵注右美托咪定复合羟考酮或舒芬太尼在麻醉重症监护室(AICU)的恢复效果。方法采用前瞻性研究的方法,选取南京市第一医院2021年2月至2022年5月择期行全身麻醉胸腔镜肺癌根治术老年患者80例,采用随机数字表法分为右美托咪定复合舒芬太尼组(S组)和右美托咪定复合羟考酮组(Q组),每组40例。两组均在术后常规监护和治疗基础上干预,Q组以羟考酮0.03 mg/(kg·h)+右美托咪定0.4μg/(kg·h)持续泵注,S组以舒芬太尼0.03μg/(kg·h)+右美托咪定0.4μg/(kg·h)持续泵注。记录入AICU后的唤醒时间、拔管时间、拔管时苏醒质量(Aldrete评分和呛咳评分)和舒适度情况[Bruggrmann舒适度量表(BCS)评分];记录入AICU后3、5、7、10和14 h镇静评分(Ramsay评分)和镇痛评分[疼痛数字量表(NRS)评分]及血流动力学变化[平均动态压(MAP)和心率];入AICU即刻、5 h和14 h检测血清炎性因子水平,包括肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和C反应蛋白(CRP);记录AICU期间镇痛泵按压次数、不良事件、引流管出血量及出AICU时患者总体满意度评分。结果Q组呛咳评分明显低于S组[(1.02±0.77)分比(1.88±0.34)分],Aldrete评分和BCS评分明显高于S组[(8.93±0.25)分比(5.97±0.32)分和(3.03±0.32)分比(0.93±0.52)分],差异有统计学意义(P<0.01);两组唤醒时间和拔管时间比较差异无统计学意义(P>0.05)。两组入AICU后3和5 h Ramassy评分、NRS评分、MAP和心率比较差异无统计学意义(P>0.05);Q组入AICU后7、10和14 h Ramassy评分明显高于S组,NRS评分、MAP和心率明显低于S组,差异有统计学意义(P<0.01)。两组入AICU后即刻TNF-α、IL-6和CRP比较差异无统计学意义(P>0.05);Q组入AICU后5和14 h TNF-α、IL-6和CRP明显低于S组,差异有统计学意义(P<0.01)。Q组镇痛泵按压次数、引流管出血量及恶心呕吐、呼吸抑制、嗜睡、躁动、发热和肺部感染发生率明显低于S组[(4.63±1.10)次比(18.80±1.54)次、(129.67±4.14)ml比(164.00±8.14)ml、10.0%(4/40)比52.5%(21/40)、2.5%(1/40)比25.0%(10/40)、7.5%(3/40)比47.5%(19/40)、0比20.0%(8/40)、2.5%(1/40)比22.5%(9/40)和2.5%(1/40)比20.0%(8/40)],差异有统计学意义(P<0.01或<0.05);两组均未出现严重低血压、严重心动过缓和谵妄。Q组出AICU时患者总体满意度评分明显高于S组[(3.53±0.63)分比(2.70±0.65)分],差异有统计学意义(P<0.01)。结论AICU老年胸腔镜肺癌根治术后患者持续微量泵注右美托咪定复合羟考酮能明显提高拔管期苏醒质量和舒适度,不影响拔管时间,且可有效减轻恢复早期疼痛程度、应激反应和炎性反应,降低术后不良事件发生率。

Objective To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit(AICU)in elderly patients after thoracoscopic radical surgery for lung cancer.Methods Using the method of prospective study,80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected.The patients were divided into dexmedetomidine combined with sufentanil group(S group)and dexmedetomidine combined with oxycodone group(Q group)by random digits table method with 40 cases each group.On the basis of routine monitoring and treatment after operation,the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h)and dexmedetomidine 0.4μg/(kg·h)through analgesia pump,the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h)and dexmedetomidine 0.4μg/(kg·h)through analgesia pump.The wake-up time,extubation time,awakening quality(Aldrete score and bucking score)and comfort level(Bruggrmann comfort scale score,BCS score)after entering the AICU were record;the sedation score(Ramsay score)and pain relief score(numerical rating scale score,NRS score)and hemodynamic changes(mean arterial pressure and heart rate)3,5,7,10 and 14 h after entering the AICU were record;the level of serum inflammatory factors,including tumor necrosis factor(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)immediately,5 h and 14 h after entering the AICU;press times of analgesia pump,adverse events,bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results The bucking score in Q group was significantly lower than that in S group:(1.02±0.77)scores vs.(1.88±0.34)scores,the Aldrete score and BCS score were significantly higher than those in S group:(8.93±0.25)scores vs.(5.97±0.32)scores and(3.03±0.32)scores vs.(0.93±0.52)scores,and there were statistical differences(P<0.01);there were no statistical difference in wake-up time and extubation time between two groups(P>0.05).There were no statistical difference Ramassy score,NRS score 3 and 5 h after entering the AICU,mean arterial pressure and heart rate between two groups(P>0.05);the Ramassy score 7,10 and 14 h after entering the AICU in Q group was significantly lower than that in S group,the NRS score,mean arterial pressure and heart rate were significantly lower than those in S group,and there were statistical differences(P<0.01).There were no statistical differences in TNF-α,IL-6 and CRP immediately after entering the AICU between two groups(P>0.05);the TNF-α,IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group,and there were statistical difference(P<0.01).The press times of analgesia pump,bleeding volume of drainage tube and the incidences of nausea vomiting,respiratory depression,lethargy,restlessness,fever and lung infection in Q group were significantly lower than those in S group:(4.63±1.10)times vs.(18.80±1.54)times,(129.67±4.14)ml vs.(164.00±8.14)ml,10.0%(4/40)vs.52.5%(21/40),2.5%(1/40)vs.25.0%(10/40),7.5%(3/40)vs.47.5%(19/40),0 vs.20.0%(8/40),2.5%(1/40)vs.22.5%(9/40)and 2.5%(1/40)vs.20.0%(8/40),and there were statistical differences(P<0.01 or<0.05);there was no severe hypotension,severe bradycardia and delirium in both groups.The overall satisfaction score in Q group was significantly higher than that in S group:(3.53±0.63)scores vs.(2.70±0.65)scores,and there was statistical difference(P<0.01).Conclusions Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation,without affecting the extubation time,and can effectively reduce the degree of pain,stress and inflammatory reaction in the early recovery period,and reduce the incidence of adverse events after surgery.