| 何敏琪,周瑞仁,唐小曼,李丽玲,张登春.不同剂量右美托咪定对妇科腹腔镜手术患者应激反应、血流动力学和术后认知功能的影响[J].,2021,(7):1351-1355 |
| 不同剂量右美托咪定对妇科腹腔镜手术患者应激反应、血流动力学和术后认知功能的影响 |
| Effects of Different Doses of Dexmedetomidine on Stress Response, Hemodynamics and Postoperative Cognitive Function in Patients Undergoing Gynecological Laparoscopic Surgery |
| 投稿时间：2020-09-24 修订日期：2020-10-18 |
| DOI：10.13241/j.cnki.pmb.2021.07.033 |
| 中文关键词: 右美托咪定 腹腔镜手术 认知功能 血流动力学 应激反应 |
| 英文关键词: Dexmedetomidine Laparoscopy surgery Cognitive function Hemodynamics Stress response |
| 基金项目:广西壮族自治区自然科学基金项目(BK2014593)；南宁市科学研究与技术开发计划项目（20143155） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量右美托咪定对妇科腹腔镜手术患者血流动力学、术后认知功能以及应激反应的影响。方法：选取2016年3月～2018年5月在我院行妇科腹腔镜手术的150例患者，按照随机数字表法分为甲、乙、丙三组，各50例，甲组在麻醉诱导后以0.8 μg?kg-1?h-1的速率输注右美托咪定，乙组在麻醉诱导后以0.4 μg?kg-1?h-1的速率输注右美托咪定，丙组给予患者注射等量生理盐水，对比不同时间点三组患者血流动力学变化情况、应激指标、麻醉恢复时间、气腹时间、拔管时间、麻醉恢复室（PACU）停留时间、改良镇静-躁动评分(RASS)、不良反应发生率，统计患者术后认知功能障碍 (POCD)发生情况。结果：T0（麻醉诱导前10 min）时，三组HR、MAP对比差异无统计学意义（P＞0.05）；T1（气管插管后1 min）、T2（气腹后5 min）时，甲组、乙组HR、MAP均低于丙组，甲组HR、MAP低于乙组（P＜0.05）；T3（术毕）时，甲组、乙组HR均低于丙组（P＜0.05），甲、乙、丙三组MAP对比，差异无统计学意义（P＞0.05）。甲、乙两组术后1 h、6 h、12 h时RASS评分均低于丙组（P＜0.05），甲组术后1 h、6 h、12 h时RASS评分低于乙组（P＜0.05）；T1、T2、T3时，甲组、乙组去甲肾上腺素（NA）、促肾上腺皮质激素（ACTH）水平均低于丙组，甲组NA、ACTH水平均低于乙组（P＜0.05）。甲、乙组拔管时间、PACU停留时间均短于丙组，甲组短于乙组（P＜0.05）。甲组、乙组、丙组术后POCD发生率为2.00%（1/50）、10.00%（5/50）、24.00%（12/50），甲组POCD发生率低于丙组（P＜0.05）。三组麻醉恢复时间、气腹时间、不良反应发生率相比较，差异无统计学意义（P＞0.05）。结论：妇科腹腔镜术患者围术期应用右美托咪定有利于维持血流动力学稳定，减轻应激反应，降低术后认知功能障碍发生率，其中0.8 μg?kg-1?h-1右美托咪定作用更明显。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of dexmedetomidine on postoperative cognitive function, hemodynamics and stress response in patients undergoing laparoscopic gynecological surgery. Methods: 150 cases of gynecological laparoscopic surgery in our hospital from March 2016 to May 2018 were selected as the study object, they were divided into three groups according to random number table method. dexmedetomidine was infused at a rate of 0.8 μg?kg-1?h-1 in group A, dexmedetomidine was infused at a rate of 0.4 μg?kg-1?h-1 in group B after anesthesia induction, while patients in the group C was given the same amount of normal saline. The hemodynamic changes, stress indicator, anaesthesia recovery time, pneumoperitoneum time, extubation time, residence time of PACU, improved sedation - agitation score (RASS) were compared among the three groups at different time points. The the occurrence of postoperative cognitive dysfunction (POCD) in the patients were recorded. Results: At T0(10 minutes before anesthesia induction), there were no significant differences in HR and MAP in the three groups (P>0.05). At T1(1 min after tracheal intubation) and T2(5min after pneumoperitoneum), HR and MAP in group A and group B were lower than those in group C, while HR and MAP in group A were lower than those in group B (P<0.05). At T3(end of surgery), HR in group A and group B were lower than that in group C (P<0.05). There were no significant differences in group A, group B and group C (P>0.05). The RASS score of group A and group B at 1 h, 6 h and 12 h after surgery were lower than that of group C (P<0.05), while that of group A at 1h, 6h and 12h after surgery was lower than that of group B (P<0.05). At T1, T2 and T3, the levels of Norepinephrine(NA) and Adrenocorticotropic hormone(ACTH) in group A and group B were lower than those in group C, while those in group A were lower than those in group B (P<0.05). The incidence of postoperative POCD in group A, group B, group C were 2.00% (1/50), 10.00% (5/50), 24.00% (12/50) respectively, the incidence of POCD in group A was lower than that in group C(P<0.05). There was no significant difference in the recovery time of anesthesia and pneumoperitoneum in the three groups (P>0.05). Conclusion: The perioperative application of dexmedetomidine in gynecological laparoscopic surgery is conducive to maintaining hemodynamic stability, reducing stress response and reducing the incidence of postoperative cognitive dysfunction, of which the effect of 0.8 μg?kg-1?h-1 dexmedetomidine is more obvious. |
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