右美托咪定对老年妇科肿瘤患者术后低氧血症的预防作用及其安全性的临床研究

Clinical study on the preventive effects and safety of dexmedetomidine on postoperative hypoxemia in elderly patients with gynecological tumors

目的观察右美托咪定对老年妇科肿瘤患者行下腹部开腹手术后低氧血症的预防作用。方法纳入2023年8月—2024年2月于复旦大学附属肿瘤医院行下腹部开腹手术的老年妇科肿瘤患者78例,以随机数字表法随机分为Dex组(n=39)和对照组(n=39)。Dex组患者进入手术室后给予0.5μg/kg负荷剂量的右美托咪定,插管后给予0.2μg/(kg·h)维持量持续泵注;对照组患者给予等量的生理盐水。测定和比较2组麻醉开始前(T1)、拔管后15 min(T2)、拔管后30 min(T3)、拔管后1 h(T4)的心率、舒张压、收缩压和血氧饱和度(SpO_(2))等指标值;记录并比较2组患者T1和T3的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、在拔管1 h内低氧血症(SpO_(2)<90%)发生情况、术后疼痛数字评定量表(NRS)评分和术后镇静Ramsay评分;观察并比较2组患者术中心动过缓、低血压和术后恶心呕吐的发生情况。结果与对照组比较,Dex组T3心率,T2、T4收缩压,T2舒张压值均更低,差异均有统计学意义(P<0.05)。2组各个时间点SpO_(2)、PaO_(2)和PaCO_(2)值差异均无统计学意义(P>0.05)。Dex组低氧血症发生率明显低于对照组(5.1%vs 46.2%,P<0.001)。多元逻辑回归分析显示,治疗(Dex组对比对照组)是低氧血症的独立保护因素(P=0.008,OR=0.024),高龄是低氧血症的独立风险因素(P=0.045,OR=1.181)。Dex组术后疼痛NRS评分低于对照组(P<0.001)。2组术后镇静Ramsay评分差异无统计学意义(P>0.05)。2组术中心动过缓、低血压和术后恶心呕吐发生率差异均无统计学意义(P>0.05)。结论右美托咪定可预防老年妇科肿瘤患者行下腹部开腹手术后低氧血症的发生,且耐受佳。

Objective To observe the preventive effects of dexmedetomidine on hypoxemia in elderly patients with gynecological tumors after lower abdominal open surgery.Methods 78 elderly gynecological tumor patients who underwent lower abdominal open surgery in Affiliated Cancer Hospital of Fudan University from August 2023 to February 2024 were enrolled and randomly divided into Dex group(n=39)and control group(n=39)by random number table method.Patients in the Dex group were given 0.5μg/kg load dose of dexmedetomidine after entering the operating room,and 0.2μg/(kg·h)maintenance dose of dexmedetomidine after intubation.Patients in the control group received equal amount of normal saline.The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO_(2))before sedation(T1),15 mins after extubation(T2),30 mins after extubation(T3),and 1 h after extubation(T4)of both groups were measured and compared.The arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))at T1 and T3 of both groups were measured and compared.The incidence of hypoxemia(SpO_(2)<90%)within 1 hour of extubation,as well as the postoperative pain numerical rating scale(NRS)score and postoperative sedation Ramsay score were recorded and compared between the two groups.The incidences of intraoperative bradycardia,intraoperative hypotension,and postoperative nausea and vomiting were recorded and compared between the two groups.Results Compared with the control group,HR at T3,SBP at T2 and T4,and DBP at T2 in the Dex group were all lower,and the differences were statistically significant(P<0.05).There were no significant differences in SpO_(2),PaO_(2) and PaCO_(2) values between the two groups at each time point(P>0.05).The incidence of hypoxemia in the Dex group was significantly lower than that in the control group(5.1%vs 46.2%,P<0.001).Multiple logistic regression analysis showed that treatment(Dex group vs control group)was an independent protective factor for hypoxemia(P=0.008,OR=0.024),and advanced age was an independent risk factor for hypoxemia(P=0.045,OR=1.181).The postoperative pain NRS score of the Dex group was lower than that of the control group(P<0.001).There was no significant difference in postoperative sedation Ramsay score between the two groups(P>0.05).There were no significant differences in the incidence of intraoperative bradycardia,hypotension and postoperative nausea and vomiting between the two groups(P>0.05).Conclusion Dexmedetomidine can prevent the occurrence of hypoxemia after lower abdominal open surgery in elderly patients with gynecological tumors,and it is well tolerated.