右美托咪定对老年腹腔镜手术患者苏醒期谵妄的影响

Effect of Dexmedetomidine on Emergency Delirium in the Elderly Patients Undergoing Laparoscopic Surgery

目的:评价右美托咪定对老年腹腔镜手术患者苏醒期谵妄的影响。方法:择期行腹腔镜手术老年患者80例,性别不限,年龄60~80岁,BMI 19~30,ASA分级Ⅰ或Ⅱ级。采用随机数字表法,将患者分为两组(n=40):七氟醚-瑞芬太尼组(A组)和右美托咪定-七氟醚-瑞芬太尼组(B组)。B组麻醉诱导前15min静脉持续泵注右美托咪定负荷量0.6μg/kg,随后以0.3ng/(kg·min)的速率静脉持续输注至术毕前20min;A组诱导前给予等容量生理盐水。负荷量输注完毕后3min麻醉诱导,两组均静脉注射芬太尼2~5μg/kg、丙泊酚1~2mg/kg和顺阿曲库铵0.2mg/kg,气管插管后行机械通气。麻醉维持:七氟醚(呼气末靶浓度1%~3%)吸入,静脉泵注瑞芬太尼0.05~0.1ng/(kg·min),术中维持BIS值40~60。根据BIS值来调节七氟醚和瑞芬太尼的用量,记录丙泊酚、瑞芬太尼和七氟醚的用量及苏醒期躁动和术后6h内谵妄发生情况。结果:与A组比较,B组丙泊酚、瑞芬太尼和七氟醚的用量减少,苏醒期躁动发生率及术后6h内谵妄的发生率降低(P<0.05)。结论:右美托咪定可降低老年腹腔镜手术患者术后苏醒期谵妄的发生,对术后认知功能障碍的发生有一定的防治效果。

Objective :To investigate the effect of dexmedetomidine on Emergency delirium in the elderly patients un‐dergoing laparoscopic surgery .Methods :80 cases with elderly patients haing electie line of laparoscopic surgery ,or fe‐male ,aged 60~80 years old ,BMI 19~30 ,ASA Ⅰ orⅡ .Were randomly divided into 2 groups(n=40):sevoflurane‐ruifentanyl group (group A) and dexmedetomidine‐sevoflurane‐ruifentanyl group (group B) .Dexmedetomidine 0 .6μg /kg was infused intravenously over 15min before anesthesia induction in group B and was maintained 0 .3ng/(kg · min) until to 20min before operation end ,while the same volume of normal saline was infused in group A .Facilitated with 0.15mg/kg cisatracurium besylate and the patients were mechanicallv .Ventilated Load infusion 3min after anesthesia induction ,two groups were intravenous fentanyl 2~5μg/kg ,1~2mg/kg propofol and atracurium 0 .2mg/kg ,endotra‐cheal intubation after mechanical ventilation .Maintain anesthesia :sevoflurane by target controlled inhalation (TCI) (end‐tidal concentration set at 1% ~3% ) and intravenous injection pump ,ruifentanyl 0 .05~0 .1ng/(kg · min) ,intra‐operative maintain the BIS value of 40~60 .According to the BIS values to adjust the Sevoflurane and dosage of ruifent‐anyl ,the consumption of propofol ,ruifentanyl ,and sevoflurane ,agitation during emergenee from anesthesia ,and postop‐erative delirium within 6h after operation were recorded .Results:Compared with group A ,group B propofol ,ruifenta‐nyl and sevoflurane was significantly reduced ,and the incidences of agitation during emergence from anesthesia and postoperative delirium within 6h after operation were significantly decreased in group B (P<0.05) .Conclusion:Dexme‐detomidine can reduce the incidence of elderly patients with laparoscopic surgery postoperative emergency delirium ,for prevention and control of the occurrence of postoperative cognitive dysfunction has certain effect .