摘要
目的:探讨右美托咪定复合利多卡因持续泵注对老年胃癌根治术后谵妄的影响。方法:选取择期行胃癌根治术的老年患者200例,随机分为:对照组、利多卡因组、右美托咪定组、右美托咪定复合利多卡因组(联合组)(n=50)。观察比较四组患者术中麻醉相关指标,术后1d、2 d、3d采用谵妄测评量表中文修订版(The confusion assessment method-Chinese revision,CAM⁃CR)测定谵妄的发生;麻醉诱导前、术后即刻、术后1 d及3 d采用酶联免疫吸附实验(Enzyme linked immunosorbent assay,ELISA)测定血清神经元特异性烯醇化酶(Neuron-specific enolase,NSE)和S-100β蛋白水平。结果:四组患者麻醉相关指标差异有统计学意义(P<0.05),用药组时间皆短于对照组;术后3天内,四组患者CAM-CR评分以及T2、T3时刻血清NSE、S-100β水平差异有统计学意义(P<0.05),用药组均低于对照组,联合组低于利多卡因、右美托咪定组;四组患者谵妄发生率依次降低(P<0.05)。结论:右美托咪定复合利多卡因持续泵注有利于降低老年胃癌根治术患者谵妄发生率,可能与减少麻醉药用量、降低血清NSE和S-100β水平有关。
Objective:To investigate the effects of continuous infusion of dexmedetomidine and Lidocaine on early postoperative cognitive function and delirium in elderly patients undergoing radical gastrectomy.Methods:Two hundred elderly patients with gastric cancer who underwent radical gastrectomy in our hospital were selected from June 2019 to June 2020,and were randomly divided into the control group,Lidocaine group,dexmedetomidine group,dexmedetomidine combined with the Lidocaine group(combined group)(n=50).The related indicators of anesthesia were observed,and CAM-CR was used to evaluate the occurrence of delirium one day,two days and three days postoperative.ELISA was used to detect NSE,and S-100βprotein levels at anesthesia induction,at the end of the surgery,one day,and three days postoperative.Results:There were significant differences in anesthesia relative outcomes(P<0.05),and the time of the medication group was all shorter than the control group.At T3 and T4,the MMSE scores of the four groups were significantly different(P<0.05).Three days after the operation,the cam-cr score and serum NSE and S-100βlevels at T2 and T3 in the four groups were significantly different(P<0.05).The medication group was lower than the control group,the combined group was lower than the lidocaine group and the dexmedetomidine group.The incidence of suspicious delirium and delirium in the four groups decreased in turn(P<0.05).Conclusion:Continuous infusion of dexmedetomidine combined with Lidocaine can improve early postoperative cognitive function and reduce the incidence of delirium in elderly patients with gastric cancer after the radical operation.The mechanism may be related to the decrease in the dosage of narcotic drugs and the decrease in serum NSE and S-100βlevels.
作者
古小平
袁利帮
黄青青
任玲
古学东
Gu Xiao-ping;Yuan Li-bang;Huang Qing-qing;Ren Ling;Gu Xue-dong(Department of Anesthesiology,Western Theater Command General Hospital,Chengdu 610000,China)
出处
《四川生理科学杂志》
2022年第10期1706-1709,1753,共5页
Sichuan Journal of Physiological Sciences
基金
2019军队后勤科研项目(编号CLB19J051)。
关键词
右美托咪定
利多卡因
老年
胃癌根治术
谵妄
Dexmedetomidine
Lidocaine
Elderly
Radical gastrectomy
Cognitive function
Delirium
