摘要
目的探讨在帕金森病(PD)行脑深部电刺激术(DBS)联合起搏器植入术(IPG)中应用右美托咪定的效果和安全性。方法选取2016年9月至2020年6月南通市第四人民医院收治的84例行双侧立体定向DBS+IPG植入术的PD患者作为研究对象,按随机数字表法分成观察组和对照组,各42例。对照组给予常规全麻措施,观察组术中加用右美托咪定,观察两组的术中血流动力学、镇静、术后精神认知等指标。结果与T0比较,两组T1~T4的心率(HR)、平均动脉压(MAP)和Narcotrend指数(NTI)指数均下降(P<0.05),观察组的变化幅度小于对照组(P<0.05);与T0比较,两组T1~T4的两组Ramsay评分升高,观察组的变化幅度大于对照组(P<0.05)。与术前1 d比较,两组的术后1 d和3 d的老年谵妄测验(CAM-CR)评分较前升高,生活舒适度评分(ADL)和简易精神状态(MMSE)评分下降(P<0.05),术后5 d均逐渐恢复正常,两组的变化幅度无差异(P>0.05)。观察组术中谵妄、苏醒期躁动和围术期心血管不良事件率低于对照组(P<0.05),两组药物不良反应率无差异(P>0.05)。结论在行DBS联合IPG术的PD患者术中使用右美托咪定,能提高镇静和镇痛效果,用药安全性较高。
Objective To investigate the efficacy and safety of dexmedetomidine in deep brain stimulation(DBS)combined with pacemaker implantation(IPG)in patients with Parkinson's disease(PD).Methods Totally 84 PD patients admitted to Nantong No.4 People's Hospital from September 2016 to June 2020 who underwent bilateral stereotype-directed DBS+IPG implantation were selected as the research objects,and were divided into observation group and control group according to random number table,with 42 patients in each group.The control group was given routine general anesthesia,the observation group was intraoperative with dexmedetomidine,intraoperative hemodynamics,sedation,postoperative mental cognition and other indicators were observed in the two groups.Results Heart rate(HR),mean arterial pressure(MAP)and Narcotrend's index(NTI)were decreased in both groups at T1-T4 compared with T0(P<0.05),and the change in the observation group was less than that in the control group(P<0.05),while the Ramsay score increased in both groups at T1-T4 compared with T0,and the change in the observation group was greater than that in the control group(P<0.05).Compared with 1 d before surgery,the geriatric delirium test(CAM-CR)scores at 1 d and 3 d after surgery in both groups increased compared with those before,the life comfort score(ADL)and mini mental state(MMSE)scores decreased(P<0.05),and gradually returned to normal at 5 d after surgery;there was no difference in the magnitude of change between the two groups(P>0.05).The rates of intraoperative delirium,awakening agitation and perioperative cardiovascular adverse events in the observation group were lower than those in the control group(P<0.05),and the rates of adverse drug reactions did not differ between the two groups(P>0.05).Conclusion The intraoperative use of dexmedetomidine in PD patients undergoing DBS combined with IPG resulted in improved sedation and analgesia,with a high safety profile.
作者
吉贵平
周育南
JI Guiping;ZHOU Yunan(Nantong No.4 People's Hospital,Nantong,Jiangsu 226001,China)
出处
《大医生》
2020年第23期33-35,共3页
Doctor
