右美托咪定复合艾司氯胺酮对老年食管癌根治术患者的镇静镇痛效果、苏醒质量及认知功能的影响

Effects of dexmedetomidine combined with esketamine on sedation and analgesia,wake-up quality and cognitive function of elderly patients undergoing radical esophagectomy

目的分析右美托咪定复合艾司氯胺酮对老年食管癌根治术患者的镇静镇痛效果、苏醒质量及认知功能的影响。方法选取新疆医科大学第一附属医院2020年8月至2023年7月收治的102例拟行根治性手术治疗的老年食管癌患者为研究对象,使用简单随机法配合随机数字表法将入选患者分为复合组(n=51)和对照组(n=51)。两组术中均泵注右美托咪定维持麻醉,复合组麻醉诱导时给予艾司氯胺酮0.25 mg/kg静脉滴注,术中视麻醉深度追加艾司氯胺酮1 mg/kg静脉注射。记录两组患者入室时(T1)、手术开始前1 min(T2)、手术开始后3 min(T3)、手术结束时(T4)、苏醒时(T5)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和血氧饱和度(oxygen saturation,SpO_(2))变化,评估两组患者镇静镇痛效果、苏醒质量和认知功能变化,并记录不良反应。结果两组患者T2、T3、T4、T5的MAP、HR较T1均显著降低(均P<0.05),且复合组患者MAP、HR均显著低于对照组同时点水平(均P<0.05)。复合组T2、T3的SpO_(2)均显著高于对照组同时点水平(均P<0.05)。两组患者术后12 h的视觉模拟评分法评分均显著高于术后6 h(均P<0.05),复合组患者术后6 h、术后12 h、术后24 h的视觉模拟评分法评分均显著低于对照组(均P<0.05)。复合组患者苏醒时间、躁动发生率、术后2 h Ricker镇静-躁动评分均显著低于对照组(均P<0.05),术后2 h时Ramsay评分显著高于对照组(P<0.05)。两组患者术后1 d、术后3 d简易精神状态量表(minimum mental state examination,MMSE)评分均显著低于本组术前1 d(均P<0.05),复合组患者术后1 d、术后3 d MMSE评分均显著高于对照组患者(均P<0.05),术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率显著低于对照组(P<0.05)。两组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论与单纯应用右美托咪定,复合艾司氯胺酮能够达成更理想的食管癌根治术中、术后镇静镇痛效果,对于提高苏醒质量、降低术后POCD风险更有益,且安全性良好。

Objective To analyze the effects of dexmedetomidine combined with esketamine on sedation and analgesia,awakening quality and cognitive function in elderly patients undergoing radical resection of esophageal cancer.Method 102 elderly patients with esophageal cancer who were treated by radical operation in The First Affiliated Hospital of Xinjiang Medical University from August 2020 to July 2023 were enrolled,and they were divided into compound group(n=51)and control group(n=51)by simple random method combined with random number table.Dexmedetomidine was pumped to maintain anesthesia in both groups during the operation.The 0.25 mg/kg of esketamine was given intravenously in the compound group during anesthesia induction,and 1 mg/kg of esketamine was added intravenously during the operation according to the depth of anesthesia.The mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO_(2))were recorded at the time of entering operation room(T1),1 minute before operation(T2),3 minutes after operation(T3),the end of operation(T4)and recovery(T5).The effects of sedation and analgesia,the quality of awakening and the changes of cognitive function were evaluated,and the adverse reactions of the two groups were recorded.Result The MAP and HR in T2,T3,T4,and T5 patients in both groups were significantly lower than those in T1(all P<0.05),and the compound group was significantly lower than the control group at the same time point(all P<0.05).The SpO_(2) levels of T2 and T3 in the compound group patients were significantly higher than those in the control group at the same time point.The visual analogue scale,scores of both groups of patients at 12 hours postoperatively were significantly higher than those at 6 hours postoperatively(all P<0.05),while the composite group had significantly lower scores at 6 hours postoperatively,12 hours postoperatively,and 24 hours postoperatively than the control group(all P<0.05).The recovery time,restlessness incidence rate,and Ricker sedation restlessness score at 2 hours after surgery in the composite group were significantly lower than those in the control group(all P<0.05),and the Ramsay score at 2 hours after surgery was significantly higher than that in the control group(P<0.05).The minimum mental state examination(MMSE)scores of both groups of patients were significantly lower than those before surgery on one day and three days after surgery(all P<0.05).The MMSE scores of the composite group were significantly higher than those of the control group on one day and three days after surgery(all P<0.05),and the incidence of postoperative cognitive dysfunction(POCD)was significantly lower than that of the control group(P<0.05).There was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups of patients(P>0.05).Conclusion Compared with dexmedetomidine alone,the combination of esmketamine can achieve more ideal sedative and analgesic effects during and after radical resection of esophageal cancer,which is beneficial to improve the quality of awakening and reduce the risk of POCD after operation,and has good safety.