老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果及对应激反应的影响

Sedative effect of dexmedetomidine with combined spinal-epidural anesthesia and its impact on stress response in elderly patients with prostatic hyperplasia undergoing plasmakinetic resection of prostate

摘要:

目的 探讨老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果及对应激反应的影响。方法 前瞻性选取2022年1月—2023年4月在安徽医科大学附属滁州医院行等离子电切术的102例老年前列腺增生患者，按照随机数字表法分为对照组和研究组，每组51例。对照组给予咪达唑仑复合腰硬联合麻醉，研究组给予右美托咪定复合腰硬联合麻醉。对比两组苏醒时间、围手术期血流动力学、术中寒颤、疼痛、认知功能、炎症反应、应激反应情况及不良反应情况。结果 研究组苏醒时间短于对照组（P <0.05）。两组麻醉诱导前、切皮时、术毕时的平均动脉压、心率比较，结果 ①不同时间点平均动脉压、心率比较，差异均有统计学意义（F =8.523和7.961，均P =0.000）；②两组平均动脉压、心率比较，差异均有统计学意义（F =8.036和8.185，均P =0.000）；③两组平均动脉压、心率变化趋势比较，差异均有统计学意义（F =8.654和8.235，均P =0.000）。研究组寒颤发生率低于对照组（P<0.05）。两组术后4 h、12 h、24 h、48 h的疼痛视觉模拟评分（VAS）比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =8.935，P =0.000）；②两组VAS评分比较，差异有统计学意义（F =7.419，P =0.000）；③两组VAS评分变化趋势比较，差异有统计学意义（F =7.128，P =0.000）。两组术前、术后24 h、48 h的简易精神状态检查（MMSE）评分比较，两组术前、术后24 h、48 h的MMSE评分比较，结果 ①不同时间点MMSE评分比较，差异有统计学意义（F =7.986，P =0.000）；②两组MMSE评分比较，差异无统计学意义（F =0.171，P =0.841）；③两组MMSE评分变化趋势比较，差异无统计学意义（F =0.315，P =0.702）。两组开始麻醉时、术后24 h、术后48 h的白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）比较，结果 ①不同时间点TNF-α、IL-6比较，差异均有统计学意义（F =8.517和8.613，均P =0.000）；②两组TNF-α、IL-6比较，差异均有统计学意义（F =7.987和7.543，均P =0.000）；③两组TNF-α、IL-6变化趋势比较，差异均有统计学意义（F =7.968和7.741，均P =0.000）。两组术前、术后24 h、术后48 h的肾上腺素（Adr）、皮质醇（Cor）比较，结果 ①不同时间点Adr、Cor比较，差异均有统计学意义（F =8.001和8.547，均P =0.000）；②两组Adr、Cor比较，差异均有统计学意义（F =7.958和7.874，均P =0.000）；③两组的Adr、Cor变化趋势比较，差异均有统计学意义（F =8.147和7.959，均P =0.000）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果显著，可减轻患者围手术期疼痛、炎症反应及应激反应，维持围手术期血流动力学稳定，且安全可靠。

Abstract:

Objective To investigate the sedative effect of dexmedetomidine with combined spinal-epidural anesthesia and its impact on stress response in elderly patients with prostatic hyperplasia undergoing plasmakinetic resection of prostate.Methods A total of 102 elderly patients with prostatic hyperplasia who underwent plasmakinetic resection of prostate in our hospital from January 2022 to April 2023 were prospectively selected and divided into the control group and the study group by the random number table method, with 51 cases in each group. The control group was given midazolam with combined spinal-epidural anesthesia, and the study group was given dexmedetomidine with combined spinal-epidural anesthesia. The recovery time, perioperative hemodynamics, intraoperative shivering, pain, cognitive function, inflammatory response, stress response and adverse reactions were compared between the two groups.Results The recovery time of the study group was shorter than that of the control group (P < 0.05). The mean arterial pressure and the heart rate in the two groups before anesthesia induction, at skin incision, and after surgery were compared, which showed that they were different among the time points (F = 8.523 and 7.961, both P =0.000) and between the groups (F = 8.036 and 8.185, both P = 0.000), and that the change trends of them were significantly different between the two groups (F = 8.654 and 8.235, both P = 0.000). The incidence of shivering in study group was lower than that in the control group (P < 0.05). The comparison of Visual Analogue Scale (VAS) scores in the two groups 4 h, 12 h, 24 h and 48 h after surgery demonstrated that they were different among the time points (F = 8.935, P = 0.000) and between the groups (F = 7.419, P = 0.000), and that the change trends of them were different between the groups (F = 7.128, P = 0.000). The comparison of Mini Mental State Examination (MMSE) scores in the two groups before and 24 h and 48 h after surgery via repeated measures analysis of variance revealed that they were different among the time points (F = 7.986, P = 0.000) but not between the two groups (F = 0.171, P = 0.841), and that the change trends of them were not different between the two groups (F = 0.315, P = 0.702). The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups at anesthesia and 24 h and 48 h after surgery were compared, and the results exhibited that they were different among the time points (F = 8.517 and 8.613, both P = 0.000) and between the two groups (F = 7.987 and 7.543, both P = 0.000), and that the change trends of them were also different between the two groups (F = 7.968 and 7.741, both P = 0.000). The comparison of the levels of adrenaline (Adr) and cortisol (Cor) in the two groups before and 24 h and 48 h after surgery indicated that they were different among the time points (F = 8.001 and 8.547, both P = 0.000) and between the two groups (F = 7.958 and 7.874, both P = 0.000), and that the change trends of them were different between the two groups (F = 8.147 and 7.959, both P = 0.000). There was no difference in the overall incidence of adverse reactions in two groups (P > 0.05).Conclusion Dexmedetomidine with combined spinal-epidural anesthesia has a significant sedative effect in elderly patients with prostatic hyperplasia undergoing plasmakinetic resection of prostate. It ameliorates perioperative pain, mitigates inflammatory response and stress response, and facilitates the perioperative hemodynamic stability in a safe and reliable manner.