| 梁彦秋,司玉坤,刘景秋,黄秋坤,王景需.不同剂量右美托咪定辅助麻醉对老年结肠癌根治术患者麻醉效果和术后谵妄的影响及谵妄的相关因素分析[J].,2022,(22):4336-4340 |
| 不同剂量右美托咪定辅助麻醉对老年结肠癌根治术患者麻醉效果和术后谵妄的影响及谵妄的相关因素分析 |
| Different Dosages of Dexmedetomidine Assisted Anesthesia on Anesthetic Effect and Effects of Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer and Analysis of Related Factors of Delirium |
| 投稿时间：2022-05-07 修订日期：2022-05-31 |
| DOI：10.13241/j.cnki.pmb.2022.22.026 |
| 中文关键词: 不同剂量 右美托咪定 老年 结肠癌根治术 麻醉效果 谵妄 |
| 英文关键词: Different dosages Dexmedetomidine Elderly Radical resection of colon cancer Anesthetic effect Delirium |
| 基金项目:河北省医学科学研究课题计划项目（20190284）；保定市科技计划项目（2141ZF167） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量右美托咪定辅助麻醉对老年结肠癌根治术患者麻醉效果，并分析术后谵妄的影响因素。方法：选取2019年4月~2021年1月期间我院收治的160例老年结肠癌根治术患者，根据随机数字表法将患者分为A组（53例）、B组（53例）和C组（54例）。A组和B组均于麻醉诱导前给予0.5 μg/kg右美托咪定，以0.2 μg/kg?h速率静脉输注至手术结束前30 min，A组术后镇痛时再给予右美托咪定0.05 μg/kg?h。C组给予等容量和等速率的生理盐水。观察三组的应激反应、麻醉效果、不良反应发生率、谵妄发生率。根据是否发生谵妄分为谵妄组（n=28）和无谵妄组（n=132）。采用Logistic回归分析术后谵妄的影响因素。结果：三组术后第3 d C反应蛋白（CRP）、白介素-6（IL-6）、多巴胺、肾上腺素均较手术结束升高（P<0.05）。A组、B组术后第3 d CRP、IL-6、多巴胺、肾上腺素低于C组（P<0.05）。A组、B组术后第3dCRP、IL-6、多巴胺、肾上腺素组间对比，无明显差异（P>0.05）。A组、B组、C组的不良反应总发生率组间的对比无明显差异（P>0.05）。B组的谵妄发生率明显低于A组、C组（P<0.05）。A组、C组谵妄发生率组间对比无明显差异（P>0.05）。单因素分析结果显示，术后谵妄的发生与年龄、术前抑郁、术前合并基础疾病数量、术中低氧血症、气腹后PaCO2、白蛋白有关（P<0.05）。多因素Logistic回归分析结果显示：术前抑郁、年龄≥70岁、术前合并基础疾病数量≥3、术中低氧血症、气腹后PaCO2偏高、白蛋白偏低是导致老年结肠癌根治术患者术后谵妄的危险因素（P<0.05）。结论：小剂量右美托咪定辅助麻醉可提高老年结肠癌根治术患者的麻醉效果，减少谵妄的发生率，同时术前抑郁、年龄≥70岁、术前合并基础疾病数量≥3、术中低氧血症、气腹后PaCO2偏高、白蛋白偏低是引起谵妄发生的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the anesthetic effect of different dosages of dexmedetomidine in elderly patients undergoing radical resection of colon cancer, and to analyze the influencing factors of postoperative delirium. Methods: 160 cases of elderly patients undergoing radical resection of colon cancer who were treated in our hospital from April 2019 to January 2021 were selected, and they were randomly divided into group A (53 cases), group B (53 cases) and group C (54 cases) according to the random number table method. Group A and group B were given 0.5 μg/kg dexmedetomidine before induction of anesthesia, and at a rate of 0.2 μg/kg?h by intravenous infusion to 30 min before the end of operation. Group A was given dexmedetomidine 0.05 μg/kg?h during postoperative analgesia. Group C was given normal saline of equal volume and equal rate. The stress response, anesthetic effect, incidence of adverse reactions and incidence of delirium were observed in the three groups. They were divided into delirium group (n=28) and no delirium group (n=132) according to whether occurrence of delirium. Logistic regression were used to analyze the influencing factors of postoperative delirium. Results: The C reactive protein (CRP), interleukin-6 (IL-6), dopamine and adrenaline in the three groups at 3 d after operation were increased compared with those at the end of operation (P<0.05). CRP, IL-6, dopamine and epinephrine in the group A and the group B at 3 d after operation were lower than those in group C (P<0.05). There were no significant differences in CRP, IL-6, dopamine and adrenaline between group A and group B at 3 d after operation (P>0.05). There was no significant difference in the total incidence of adverse reactions in the group A, group B and group C (P>0.05). The incidence of delirium in the group B was significantly lower than that in the group A and the group C (P<0.05). There was no significant difference in the incidence of delirium between group A and group C (P>0.05). Univariate analysis showed that the occurrence of postoperative delirium was related to age, preoperative depression, the number of preoperative combined basic diseases, intraoperative hypoxemia, PaCO2 after pneumoperitoneum and albumin (P<0.05). The results of multivariate Logistic regression analysis showed that preoperative depression, age ≥70 years, the number of preoperative combined basic diseases ≥3, intraoperative hypoxemia, high PaCO2 after pneumoperitoneum and low albumin were the risk factors for postoperative delirium in elderly patients undergoing radical resection of colon cancer (P<0.05). Conclusion: The low dose dexmedetomidine assisted anesthesia can improve the anesthetic effect of elderly patients undergoing radical resection of colon cancer, and reduce the incidence of delirium. Meanwhile, preoperative depression, age ≥70 years, the number of preoperative combined basic diseases ≥3, intraoperative hypoxemia, high PaCO2 after pneumoperitoneum and low albumin are the risk factors for occurrence of delirium. |
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