右美托咪定复合丙泊酚对经尿道前列腺电切术患者血流动力学、全麻苏醒期躁动及认知功能的影响

Effects of dexmedetomidine combined with propofol on hemodynamics,emergence agitation and cognitive function in patients undergoing transurethral resection of prostate

目的:研究右美托咪定(Dex)复合丙泊酚对经尿道前列腺电切术(TURP)患者血流动力学、全麻苏醒期躁动(EA)及认知功能的影响。方法:选择行TURP的患者96例,依据随机数字表法分为试验组(n=48)、对照组(n=48)。对照组行丙泊酚麻醉,试验组行Dex复合丙泊酚麻醉。观察两组麻醉前(T_(0))、麻醉完成时(T_(1))、病灶切除时(T_(2))、完成手术时(T_(3))、置入输尿管时(T_(4))、苏醒时(T_(5))等时点的平均动脉压(MAP)、心率(HR)等血流动力学指标,拔管15 min时(T6)疼痛、镇静情况,苏醒时EA发生情况。术前、术后3 d认知功能情况及术后不良反应发生情况。结果:试验组苏醒时间、首次下床时间、首次进食时间及住院时间均短于对照组(均P<0.05),两组手术时间比较无统计学差异(P>0.05);T0时两组MAP、HR比较无统计学差异(均P>0.05),T_(1)时两组HR比较无统计学差异(P>0.05),T_(1)、T_(3)~T_(5)时试验组MAP均低于对照组,T_(2)~T_(5)时试验组HR高于对照组,T2时试验组MAP高于对照组(均P<0.05);T_(6)时试验组VAS评分、Ramsay评分均低于对照组(均P<0.05);试验组EA不同分级情况优于对照组(均P<0.05);试验组EA发生率低于对照组(P<0.05);术后3 d试验组MMSE评分高于对照组(P<0.05);试验组术后不良反应发生率低于对照组(P<0.05)。结论:Dex复合丙泊酚可有效促进TURP患者术后恢复,减轻术后疼痛,维持其围术期血流动力学的稳定性,避免EA的发生,对患者认知功能影响小,且安全性高。

Objective:To study the effects of dexmedetomidine(Dex)combined with propofol on hemodynamics,emergence agitation(EA)and cognitive function in patients undergoing transurethral resection of prostate(TURP)under general anesthesia.Methods:A total of 96 ureteral calculi patients who received TURP were selected and divided into experimental group(48 cases)and control group(48 cases)according to random number table method.The control group was given propofol anesthesia,and the experimental group underwent Dex complex propofol anesthesia.The mean arterial pressure(MAP),heart rate(HR)and other hemodynamic indexes of the two groups before anesthesia(T_(0)),at the completion of anesthesia(T_(1)),at the time of lesion removement(T_(2)),at the completion of surgery(T_(3)),at the placement of ureter(T_(4)),at the time of recovery(T_(5)),and the pain and sedation 15 minutes after extubation(T 6),EA occurrence at the time of recovery,the cognitive function before and 3 days after surgery,and postoperative adverse reactions were observed.Results:The waking time,the first time to get out of bed,the first time to eat and the length of hospital stay in the experimental group were shorter than those in the control group(all P<0.05).There was no difference in operation time between the two groups(P>0.05).At T_(0),there were no differences in MAP and HR between the two groups(all P>0.05).At T_(1),there was no difference in HR between the two groups(P>0.05).At T_(1) and T_(3) to T_(5),MAP of the experimental group was lower than that of the control group(P<0.05).At T_(2) to T 5,HR of the experimental group was higher than that of the control group(P<0.05).At T 2,MAP of the experimental group was higher than that of the control group(P<0.05).At T 6,VAS score and Ramsay score of the experimental group were lower than those of the control group(all P<0.05).Different grades of EA in experimental group were better than those in control group(P<0.05).The incidence of EA in experimental group was lower than that in control group(P<0.05).At 3 days after surgery,the MMSE score of the experimental group was higher than that of the control group(P<0.05).The incidence of postoperative adverse reactions in experimental group was lower than that in control group(P<0.05).Conclusion:Dex combined with propofol can effectively promote postoperative recovery in patients with TURP,reduce postoperative pain,maintain perioperative hemodynamic stability,avoid EA,small impact on the patient’s cognitive function,with high safety.