右美托咪定复合全身麻醉对TURP老年患者应激和术后早期认知功能的影响

Effects of dexmedetomidine combined with general anesthesia on stress and early postoperative cognitive function in elderly patients undergoing transurethral resection of prostate

目的:研究右美托咪定复合全身麻醉对经尿道前列腺电切术(TURP)老年患者应激和术后早期认知功能的影响。方法:回顾性分析2022年7月至2023年7月本院收治的72例行TURP治疗的老年患者的临床资料,根据不同麻醉用药分为研究组(36例)与对照组(36例)。研究组给予右美托咪定治疗,对照组给予生理盐水。比较两组不同时间点[喉罩置入前(T_(0))、喉罩置入即刻(T_(1))、手术开始时(T_(2))、手术开始30 min(T_(3))]的平均动脉压(MAP)、心率(HR)与术前、术后1 d的应激反应指标[促肾上腺皮质激素(ACTH)、肾上腺素(AD)、皮质醇(COR)]、简易精神状态量表(MMSE)评分及术后1 d的认知功能障碍(POCD)发生率。结果:研究组T_(1)、T_(2)、T_(3)时的MAP低于对照组,差异均有统计学意义(均P<0.01);研究组T_(1)时的HR低于对照组,差异有统计学意义(P<0.01)。两组术后1 d的ACTH、AD、COR水平高于术前(均P<0.01);研究组术后1 d的ACTH、AD、COR水平低于对照组,差异均有统计学意义(均P<0.01)。两组术后1 d的MMSE评分低于术前(均P<0.05);研究组术后1 d的MMSE评分高于对照组,差异有统计学意义(P<0.01)。研究组术后1 d的POCD发生率低于对照组,差异有统计学意义[5.56%(2/36)vs.22.22%(8/36),P=0.041]。结论:TURP老年患者采用右美托咪定复合全身麻醉效果显著,可减轻患者应激反应,减少POCD风险。

Objective To investigate the effects of dexmedetomidine combined with general anesthesia on stress and early postoperative cognitive function in elderly patients undergoing transurethral resection of prostate(TURP).Methods The clinical data of 72 elderly patients who were treated with TURP admitted to our hospital from July 2022 to July 2023 were retrospectively analysed and divided into study group(36 cases)and control group(36 cases)according to different anesthetic drugs.The study group was treated with dexmedetomidine and the control group was treated with normal saline.The mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups at different time points[before laryngeal mask placement(T_(0)),immediately after laryngeal mask placement(T_(1)),at the beginning of surgery(T_(2)),30 minutes after surgery(T_(3))]and before and after surgery 1 day stress response indicators corticotropic hormone(ACTH),adrenaline(AD),cortisol(COR),Simple Mental State Scale(MMSE)scores and the incidence of postoperative cognitive dysfunction(POCD)1 day after surgery.Results The MAP of T_(1),T_(2) and T_(3) in the study group was lower than that in the control group,and the differences were statistically significant(all P<0.01).The HR of the study group at T_(1) was lower than that of the control group,and the difference was statistically significant(P<0.01).The levels of ACTH,AD and COR 1 day after operation were higher than those before operation(all P<0.01).The levels of ACTH,AD and COR in the study group were lower than those in the control group 1 day after operation,and the differences were statistically significant(all P<0.01).The MMSE score 1 day after operation was lower than that before operation,and the difference was statistically significant(P<0.05).The MMSE score of the study group was higher than that of the control group 1 day after operation,and the difference was statistically significant(P<0.01).The incidence of POCD 1 day after surgery in the study group was lower than that in the control group,and the difference was statistically significant[5.56%(2/36)vs.22.22%(8/36),χ2=4.181,P=0.041].Conclusions Dexmedetomidine combined with general anesthesia in elderly patients with TURP can significantly reduce their stress response,have less impact on early postoperative cognitive function,and reduce the risk of POCD.