右美托咪定复合硬膜外阻滞对老年腹腔镜手术患者血流动力学和认知功能的影响

Effects of Dexmedetomidine Compound Epidural Block on Hemodynamics and Cognitive Function in Elderly Laparoscopic Surgery Patients

目的:探讨右美托咪定复合硬膜外阻滞对老年腹腔镜手术患者血流动力学和认知功能的影响。方法:选取2022年1月—2023年6月于南通大学附属医院接受腹腔镜手术的老年患者76例作为研究对象,按照随机数字表分为对照组和观察组,各38例。对照组采用硬膜外阻滞复合全麻,观察组采用右美托咪定复合硬膜外阻滞。比较两组手术前后血流动力学和认知功能指标。结果:与术前比,对照组术毕、拔管时、拔管后30 min的心率(HR)和平均动脉压(MAP)上升,术毕、拔管时血氧饱和度(SPO_(2))下降,观察组术毕、拔管时HR和MAP上升,SPO_(2)下降,差异有统计学意义(P<0.05);观察组术毕、拔管时、拔管后30 min时HR、MAP低于对照组,差异有统计学意义(P<0.05)。术后4、12、24 h,两组简易智力检查量表(MMSE)评分低于术前,差异有统计学意义(P<0.05);观察组术后4、12、24 h时MMSE评分高于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定复合硬膜外阻滞应用于老年腹腔镜手术中,可以进一步稳定血流动力学指标,改善术后认知功能。

Objective:To investigate the effects of dexmedetomidine compound epidural block on hemodynamics and cognitive function in elderly laparoscopic surgery patients.Methods:Seventy-six elderly patients who underwent laparoscopic surgery in the Affiliated Hospital of Nantong University from January 2022 to June 2023 were selected as the study subjects,and were divided into the control group and the observation group according to the randomized numerical table,with thirty-eight cases in each group.The control group used epidural block compound general anesthesia,and the observation group used dexmedetomidine compound epidural block.The hemodynamic and cognitive function indexes before and after surgery were compared between the two groups.Results:Compared with the preoperative period,heart rate(HR)and mean arterial pressure(MAP)increased at the end of surgery,at the time of extubation,and 30 min after extubation in the control group,and oxygen saturation(SPO_(2))decreased at the end of surgery and at the time of extubation,while HR and MAP increased at the end of surgery and at the time of extubation in the observation group,and SPO_(2) decreased,and the difference was statistically significant(P<0.05);in the observation group,HR and MAP were lower than those in the control group at the end of operation,at the time of extubation,and 30 min after extubation,and the difference was statistically significant(P<0.05).At 4,12,and 24 h after operation,the scores of the two groups on the Brief Mental Scale of Examination(MMSE)were lower than those in the preoperative period,and the difference was statistically significant(P<0.05);in the observation group,the MMSE scores were higher than those of the control group at 4,12,and 24 h postoperatively,and the difference was statistically significant(P<0.05).Conclusion:The application of dexmedetomidine compound epidural block in geriatric laparoscopic surgery can further stabilize hemodynamic indexes and improve postoperative cognitive function.