| 刘 灿,张朝贵,阳倩虹,王 心,夏 雪.不同剂量Dex联合神经阻滞麻醉对妇科腹腔镜手术患者应激性反应因子及术后认知功能的影响[J].,2024,(17):3386-3390 |
| 不同剂量Dex联合神经阻滞麻醉对妇科腹腔镜手术患者应激性反应因子及术后认知功能的影响 |
| Effects of Different Doses of Dex Combined with Nerve Block Anesthesia on Stress Response Factors and Postoperative Cognitive Function in Patients Undergoing Gynecological Laparoscopic Surgery |
| 投稿时间：2024-02-11 修订日期：2024-02-28 |
| DOI：10.13241/j.cnki.pmb.2024.17.036 |
| 中文关键词: 右美托咪定 神经阻滞麻醉 妇科腹腔镜手术 应激反应 认知功能 |
| 英文关键词: Dexmedetomidine Nerve block anesthesia Gynecological laparoscopic surgery Stress response factors Cognitive function |
| 基金项目:四川省卫生和计划生育委员会科研项目（150254） |
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| 中文摘要: |
| 摘要 目的：观察不同剂量右美托咪定（Dex）联合神经阻滞麻醉对妇科腹腔镜手术患者应激性反应因子及术后认知功能的影响。方法：纳入2023年1月-2023年6月宜宾市第二人民医院收治的行妇科腹腔镜手术患者160例作为研究对象，根据Dex泵入的剂量将其分为低剂量组（n=53，0.2 μg?kg?h-1）、中剂量组（n=53，0.4 μg?kg?h-1）及高剂量组（n=54，0.8 μg?kg?h-1）。对比三组疼痛视觉模拟（VAS）评分、Ramsay镇静评分、血流动力学、应激性反应因子及认知功能指标水平和不良反应发生率。结果：术后12小时，高剂量组Ramsay高于中剂量组，且高剂量组、中剂量组评分高于低剂量组（P<0.05）。术后12小时，高剂量组VAS评分低于中剂量组，且高剂量组、中剂量组低于低剂量组（P<0.05）。拔管后5 min，高剂量组心率（HR）和平均动脉压（MAP）低于中剂量组，且高剂量组、中剂量组低于低剂量组（P<0.05）。拔管后5 min，高剂量组超氧化物歧化酶（SOD）高于中剂量组，且高剂量组、中剂量组高于低剂量组（P<0.05）。拔管后5 min，高剂量组去甲肾上腺素（NA）、促肾上腺皮质激素（ACTH）、丙二醛（MDA）低于中剂量组，且高剂量组、中剂量组低于低剂量组（P<0.05）。拔管后12 h，高剂量组、中剂量组简易智力状态检查量表（MMSE）评分高于低剂量组，且高剂量组高于中剂量组（P<0.05）。高剂量组术后认知功能障碍（POCD）发生率低于低剂量组和中剂量组（P<0.05）。结论：Dex应用于妇科腹腔镜手术的效果体现出剂量依赖性，其剂量为0.8 μg?kg?h-1时效果更佳，可明显降低患者的应激性损伤程度和POCD发生率，缓解术后疼痛，增加围手术期血流动力学的稳定性。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of different doses of dexmedetomidine (Dex) combined with nerve block anesthesia on stress response factors and postoperative cognitive function in patients undergoing gynecological laparoscopic surgery. Methods: 160 patients who underwent gynecological laparoscopic surgery were admitted to the Yibin Second People's Hospital from January 2023 to June 2023 were included as the study subjects, patients were divided into low dose group (n=53, 0.2 μg?kg?h-1), medium dose group (n=53, 0.4 μg?kg?h-1), and high dose group (n=54, 0.8 μg?kg?h-1) based on the dosage of Dex pump. The pain visual analogue (VAS) score, Ramsay sedation score, hemodynamics, stress response factors and cognitive function indexes and the incidence of adverse reactions were compared in three groups. Results: 12 hours after operation, the Ramsay in high dose group was higher than that in medium dose group, high dose and medium dose groups were higher than that of low dose group (P<0.05). 12 hours after operation, the VAS score in high dose group was lower than that in medium dose group, high dose and medium dose groups were lower than that of low dose group (P<0.05). 5 minutes after extubation, the heart rate (HR) and mean arterial pressure (MAP) in high dose group were lower than those in medium dose group, high dose and medium dose groups were lower than those of low dose group (P<0.05). 5 minutes after extubation, superoxide dismutase (SOD) in high dose group was higher than that in medium dose group, high dose group and medium dose group were higher than that of low dose group (P<0.05). 5 minutes after extubation, norepinephrine (NA), adrenocorticotropic hormone (ACTH) and malondialdehyde (MDA) in high dose group were lower than those in medium dose group, high dose and medium dose groups were lower than those of low dose group (P<0.05). 12 hours after extubation, the scores of mini-mental state examination (MMSE) in high dose group and medium dose group were higher than that in low dose group, and high dose group was higher than that of medium dose group (P<0.05). The incidence of postoperative cognitive dysfunction (POCD) in high dose group was lower than that in low dose group and medium dose group (P<0.05). Conclusion: The application of Dex in gynecological laparoscopic surgery shows a dose dependent effect, with a dose of 0.8 μg?kg?h-1 showing better results, which can significantly reduce the degree of stress injury and the incidence of POCD in patients, alleviate pain after operation, and increase the stability of perioperative hemodynamics. |
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