右美托咪定复合全麻在老年患者LC术中的麻醉效果分析

Analysis of anesthetic effect of dexmedetomidine combined with general anesthesia in elderly patients undergoing LC

目的 探讨右美托咪定复合全身麻醉(全麻)在老年患者腹腔镜胆囊切除术(LC)中的麻醉效果。方法 100例行LC术的老年患者,依据随机数字表法分为观察组和对照组,各50例。对照组患者给予常规全麻处理,观察组患者在对照组的基础上于全麻前15 min给予盐酸右美托咪定注射液复合麻醉。比较两组患者不同时间的血流动力学指标[平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)],认知功能评分, Ramsay评分、呛咳评分、躁动评分、视觉模拟评分法(VAS)评分,血清丙二醛(MDA)、超氧化物歧化酶(SOD)、促肾上腺皮质激素(ACTH)、皮质醇(COR)水平,不良反应发生情况。结果 手术切皮时(T1)、胆囊切除时(T2)、术毕(T3)时,两组MAP、HR、BIS水平均低于本组麻醉前20 min(T0)时,呈先降低后升高趋势,且观察组低于对照组,差异有统计学意义(P<0.05)。术后12、24、72 h,两组认知功能评分均低于T0时,呈先降低后升高趋势,但观察组(26.12±1.10)、(27.47±1.06)、(28.16±0.86)分高于对照组的(24.56±1.11)、(26.34±1.02)、(27.45±0.95)分,差异均有统计学意义(P<0.05)。术后1 h,两组呛咳评分、躁动评分、VAS评分均高于本组T0时, Ramsay评分低于本组T0时,但观察组呛咳评分(0.93±0.10)分、躁动评分(0.84±0.14)分、VAS评分(3.45±0.34)分低于对照组的(1.24±0.12)、(1.72±0.23)、(3.74±0.37)分, Ramsay评分(3.24±0.34)分高于对照组的(2.67±0.37)分,差异均有统计学意义(P<0.05)。术后1 d,两组MDA、ACTH、COR水平均高于本组T0时, SOD水平低于本组T0时,但观察组MDA(7.62±1.13)mmol/ml、ACTH(56.85±6.13)pg/ml、COR(287.43±30.31)pg/ml均低于对照组的(10.26±1.56)mmol/ml、(71.78±7.24)pg/ml、(364.76±36.74)pg/ml, SOD(52.95±6.14)U/ml高于对照组的(31.29±5.16)U/ml,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 在老年患者LC术中采用右美托咪定复合全麻,可以改善患者的血流动力学和认知功能,有效的抑制拔管时的呛咳和躁动,减轻疼痛和氧化应激反应,且镇静作用较好,对于术后的不良反应无较大影响,安全可靠。

Objective To discuss the anesthetic effect of dexmedetomidine combined with general anesthesia in elderly patients undergoing laparoscopic cholecystectomy(LC).Methods A total of 100 elderly patients undergoing LC were divided into observation group and control group according to random numerical table,with 50 cases in each group.Patients in the control group were treated with conventional general anesthesia,and patients in the observation group were given dexmedetomidine hydrochloride injection compound anesthesia 15 min before general anesthesia on the basis of the control group.Both groups were compared in terms of hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR),bispeetral index(BIS)],cognitive function score,Ramsay score,choking score,agitation score and visual analogue score(VAS)score,serum malondialdehyde(MDA),superoxide dismutase(SOD),adrenocorticotrophic hormone(ACTH),cortisol(COR)levels at different time points,and the occurrence of adverse reactions.Results At the time of skin incision(T1),at the time of gallbladder removal(T2),and at the end of surgery(T3),MAP,HR,and BIS levels in both groups were lower than those at 20 min before anesthesia(T0)in this group,with a trend of first decreasing and then increasing,and the observation group was lower than the control group.The differences were statistically significant(P<0.05).At 12,24 and 72 h postoperatively,the cognitive function scores in both groups were lower than those at T0 in this group,with a trend of first decreasing and then increasing;the cognitive function scores were(26.12±1.10),(27.47±1.06),and (28.16±0.86) points in the observation group, which were higher than those of (24.56±1.11), (26.34±1.02), and (27.45±0.95) points in the control group;the differences were all statistically significant (P<0.05). At 1 h postoperatively, the choking score, agitation score, and VAS score in both groups were higher than those at T0 in this group, and the Ramsay score was lower than that at T0 in this group;in the observation group, the choking score was (0.93±0.10) points, the agitation score was (0.84±0.14) points and VAS score was (3.45± 0.34) points, which were lower than those of (1.24±0.12), (1.72±0.23) and (3.74±0.37) points in the control group;the Ramsay score of (3.24±0.34) points in the observation group was higher than that of (2.67±0.37) points in the control group;the differences were all statistically significant (P<0.05). At 1 d postoperatively, MDA, ACTH and COR levels in both groups were higher than those at T0 in this group, and SOD level was lower than that at T0 in this group;the observation group had MDA of (7.62±1.13) mmol/ml, ACTH of (56.85±6.13) pg/ml, and COR of (287.43±30.31) pg/ml, which were lower than those of (10.26±1.56) mmol/ml, (71.78±7.24) pg/ml, and (364.76±36.74) pg/ml in the control group;SOD of (52.95±6.14) U/ml in the observation group was higher than that of (31.29±5.16) U/ml in the control group;all differences were statistically significant (P<0.05). The differences were not statistically significant when comparing the incidence of adverse reactions between the two groups (P>0.05). Conclusion Dexmedetomidine combined with general anesthesia during LC in elderly patients can improve the hemodynamics and cognitive function of patients, effectively inhibit choking and agitation during extubation, relieve pain and oxidative stress reaction, and have a good sedative effect, with no significant impact on postoperative adverse reactions, so it is safe and reliable.