右美托咪定对老年肺部手术患者术后谵妄发生率、脑氧代谢的影响

Effect of dexmedetomidine on postoperative delirium and cerebral oxygen metabolism in elderly patients undergoing pulmonary surgery

摘要:

目的 评价右美托咪定对老年肺部手术患者术后谵妄（POD）发生率、脑氧代谢的影响。方法 选取2017年9月—2022年3月在安徽医科大学附属阜阳医院接受肺部手术的120例老年患者。将患者分为研究组和对照组，各60例。研究组麻醉诱导前泵注0.5 μg/kg右美托咪定，对照组麻醉诱导前泵注等剂量的0.9%氯化钠注射液。对比两组麻醉相关药物用量、苏醒质量及POD发生率、麻醉不良反应发生率，并观察入室后5 min（T₀）、切皮时（T₁）、手术结束即刻（T₂）、术后12 h（T₃）时血流动力学指标［平均动脉压（MAP）、心率（HR）、血氧饱和度（SaO₂）］、脑氧代谢指标［左、右局部脑氧饱和度（rScO₂）］变化。结果 两组舒芬太尼用量比较，差异无统计学意义（P >0.05）。研究组丙泊酚用量、瑞芬太尼用量比对照组少，拔管时间、恢复自主呼吸时间、睁眼时间及定向力恢复时间比对照组短（P <0.05）。两组不同时间点的MAP、SaO₂、HR比较，经重复测量设计的方差分析，结果 ①不同时间点的MAP、HR比较有差异（F =43.624和39.652，均P <0.05），SaO₂比较无差异（F =2.653，P >0.05）；②两组MAP、HR比较有差异（F =85.694和93.624，均P <0.05），SaO₂比较无差异（F =4.623，P >0.05）；③两组MAP、HR变化趋势比较有差异（F =113.622和82.154，均P <0.05），SaO₂比较无差异（F =3.654，P >0.05）。两组不同时间点的左、右rScO₂比较，经重复测量设计的方差分析，结果 ①不同时间点的左、右rScO₂比较有差异（F =54.626和53.958，均P <0.05）；②两组左、右rScO₂比较有差异（F =69.874和101.698，均P <0.05）；③两组左、右rScO₂变化趋势比较有差异（F =103.652和124.698，均P <0.05）。研究组POD发生率比对照组低（P <0.05）。两组麻醉不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 右美托咪定用于老年肺部手术中可降低麻醉药物用量，提升苏醒质量，改善脑氧代谢，稳定血流动力学，减少术后POD发生。

Abstract:

Objective To evaluate the effect of dexmedetomidine on the incidence of postoperative delirium(POD) and cerebral oxygen metabolism in elderly patients undergoing pulmonary surgery.Methods The 120 elderly patients who underwent pulmonary surgery in Fuyang Hospital affiliated to Anhui Medical University from September 2017 to March 2022 were selected and grouped into the study group and the control group, with 60 patients in each group. In the study group, 0.5 g/kg dexmedetomidine of was given before anesthesia induction, and an equal volume of normal saline was given in the control group. The dosage of anesthetics, the quality of recovery, and incidences of POD and anesthesia-related adverse reactions were compared between the two groups. The hemodynamic indicators [mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SaO₂) ] and cerebral oxygen metabolism indicators [left and right regional cerebral oxygen saturation (rScO₂) were observed at 5 min after entering the operation room (T₀), skin incision (T₁), the end of surgery (T₂), and 12 h after the surgery (T₃).Results There was no difference in the dosage of sufentanil between the two groups (P >0.05). The dosages of propofol and remifentanil in the study group were lower than those in the control group, and the time to extubation, the time to recovery of spontaneous breathing, the time to eye opening and the time to recovery of orientation were shorter in the study group than those in the control group (P < 0.05). There were differences in MAP and HR (F =43.624 and 39.652, both P < 0.05) but not SaO₂ (F =2.653, P >0.05) at different time points. The MAP and HR (F =85.694 and 93.624, both P < 0.05) but not SaO₂ (F =4.623, P >0.05) were different between the two groups. Besides, the change trends of MAP and HR (F =113.622 and 82.154, both P <0.05) but not SaO₂ (F =3.654, P > 0.05) were different between the two groups. There were differences in the left and right rScO₂ at different time points (F =54.626 and 53.958, both P < 0.05) and between the two groups (F =69.874 and 101.698, both P < 0.05). The change trends of the left and right rScO₂ were also different between the two groups (F =103.652 and 124.698, both P <0.05). The incidence of POD in the study group was lower than that in the control group (P < 0.05), whereas the incidence of anesthesia-related adverse reactions was not different between the two groups (P > 0.05).Conclusions Dexmedetomidine can reduce the dosage of anesthetics, improve the quality of recovery, enhance the cerebral oxygen metabolism, stabilize hemodynamics, and decrease the incidence of POD in elderly patients undergoing pulmonary surgery.