| 宋文英,樊 龙,黄 晶,李 颖,丁 慧.小剂量右美托咪定对老年腹腔镜手术患者围术期心血管反应及应激情况的影响分析[J].,2023,(22):4304-4308 |
| 小剂量右美托咪定对老年腹腔镜手术患者围术期心血管反应及应激情况的影响分析 |
| Effect of Low-dose Dexmedetomidine on Perioperative Cardiovascular Response and Stress in elderly Patients undergoing Laparoscopic Surgery |
| 投稿时间：2023-06-06 修订日期：2023-06-30 |
| DOI：10.13241/j.cnki.pmb.2023.22.021 |
| 中文关键词: 小剂量 右美托咪定 老年 腹腔镜手术 心血管反应 应激情况 |
| 英文关键词: Low-dose Dexmetomidine Elderly Laparoscopic surgery Cardiovascular response Stress |
| 基金项目:陕西省自然科学基础研究计划项目（2021JM-550） |
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| 中文摘要: |
| 摘要 目的：探讨小剂量右美托咪定对老年腹腔镜手术患者围术期心血管反应及应激情况的影响。方法：选取2020年4月~2022年4月至陕西省人民医院行腹腔镜手术的120例老年患者作为研究对象，根据随机数字表法将其分为观察组和对照组，各60例。麻醉诱导前，观察组予以右美托咪定0.5 μg/kg静脉泵注，对照组予以等容量0.9%氯化钠注射液静脉泵注，持续时间均为10 min。术中麻醉维持，观察组予以右美托咪定0.2 μg/（kg?h）持续静脉泵注，对照组予以0.2 μg/（kg?h）速率持续静脉泵注等量氯化钠注射液，均于手术结束前30 min停止泵注。比较两组患者围术期指标、心血管反应指标、应激反应指标和炎症因子水平。结果：观察组术中舒芬太尼用量、术后24 h 静脉自控镇痛（PCIA）泵按压次数明显少于对照组，差异有统计学意义（P＜0.05）；观察组拔管时间少于对照组，但差异无统计学意义（P＞0.05）。两组患者心率（HR）、平均动脉压（MAP）组间、时间及交互比较，差异均有统计学意义（P＜0.05）；观察组气管插管即刻（T1）、气管插管后30 min（T2）和出手术室时（T3）时点HR、MAP明显低于对照组，差异有统计学意义（P＜0.05）。观察组术后丙二醛（MDA）水平明显低于对照组，过氧化氢酶（CAT）、超氧化物歧化酶（SOD）水平显著高于对照组，差异均有统计学意义（P＜0.05）。观察组术后C反应蛋白（CRP）、白介素（IL）-6及肿瘤坏死因子（TNF）-α水平均明显低于对照组，差异有统计学意义（P＜0.05）。结论：在腹腔镜手术中使用小剂量右美托咪定，可有效维持老年患者围术期血流动力学稳定，降低氧化应激反应和炎症因子水平。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of low-dose dexmedetomidine on perioperative cardiovascular response and stress in elderly patients undergoing laparoscopic surgery. Methods: A total of 120 elderly patients who underwent laparoscopic surgery in Shaanxi Provincial People's Hospital from April 2020 to April 2022 were selected as the study subjects. They were divided into an observation group and a control group according to the random number table method, with 60 cases in each group. Before anesthesia induction, the observation group received intravenous infusion of 0.5 μg/kg of dexmedetomidine, while the control group received intravenous infusion of the same volume of 0.9% sodium chloride injection, with a duration of 10 minutes. For intraoperative anesthesia maintenance, the observation group received continuous intravenous infusion of dexmedetomidine at 0.2 μg/(kg?h), while the control group received continuous intravenous infusion of the same volume of sodium chloride injection at 0.2 μg/(kg?h). The infusion was withdrew at 30 minutes before the end of surgery. Perioperative indicators, cardiovascular response indicators, stress response indicators, and inflammatory factors in the two groups were compared. Results: The dosage of sufentanil used in the observation group during surgery was significantly lower than that in the control group, and the times of pump pressing for patient-controlled intravenous analgesia (PCIA) in 24 hours after surgery was less than that in the control group (P<0.05). The extubation time in the observation group was shorter than that in the control group, but the difference was not statistically significant(P>0.05). There were statistically significant differences in heart rate (HR) and mean arterial pressure (MAP) in terms of inter-group effect, time effect and interaction effect (P<0.05). HR and MAP of the observation group were significantly lower than those of the control group at immediately after tracheal intubation (T1), 30 min after tracheal intubation (T2) and at the time of leaving the operating room (T3), and the difference was statistically significant (P<0.05). After surgery, the level of malondialdehyde (MDA) in the observation group was significantly lower than that in the control group, and the levels of catalase CAT) and superoxide dismutase (SOD) were significantly higher than those in the control group(P<0.05). After surgery, the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (TNF)-α in the observation group were significantly lower than those in the control group (P<0.05). Conclusion: Using low-dose dexmedetomidine in laparoscopic surgery can effectively maintain perioperative hemodynamic stability of elderly patients, and reduce oxidative stress reactions as well as the levels of inflammatory factors. |
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