不同剂量右美托咪定对行VATS术的高龄肺癌患者麻醉效果评价

岑盛华 乐涵波 傅海清

[摘要] 目的 分析不同劑量的Dex对行VATS术的高龄肺癌患者术后谵妄发生率及脑代谢改变的影响。 方法 将我院2017年6月～2019年1月间收治的100例行VATS术治疗的高龄患者随机分为高剂量组及低剂量组;低剂量组采用1 μg/kg Dex干预，高剂量组采用2 μg/kg Dex干预;记录两组患者谵妄发生率，在麻醉前及麻醉后对患者动脉气血进行分析，监测患者CSI评估患者麻醉深度并评估患者术后疼痛情况。 结果 高剂量组患者谵妄发生率明显低于低剂量组，且差异有统计学意义（P<0.05）;麻醉后高剂量组患者PO2及血氧饱和度均高于低剂量组，PCO2低于低剂量组，且差异有统计学意义（P<0.05）;插管前1 min、插管后3 min、手术开始时、强烈手术刺激时高剂量组患者CSI评分明显低于低剂量组，拔管前高剂量组患者CSI评分明显高于低剂量组，且差异有统计学意义（P<0.05）;术后12 h、24 h及48 h时高剂量组患者VAS评分明显低于低剂量组，且差异有统计学意义（P<0.05）。 结论 采用高剂量Dex对行VATS术的高龄患者干预后，可有效降低患者术后谵妄发生率，有效提高患者麻醉深度。

[关键词] 右美托咪定;电视胸腔镜手术;肺癌;术后谵妄;脑代谢;麻醉深度监测

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2020）15-0140-04

Evaluation of anesthetic effect of different doses of dexmedetomidine on elderly patients with lung cancer undergoing VATS

CEN Shenghua   LE Hanbo   FU Haiqing

Department of Anesthesiology， Zhoushan Hospital in Zhejiang Province， Zhoushan   316000， China

[Abstract] Objective To analyze the effects of different doses of dexmedetomidine（Dex） on the incidence of delirium and brain metabolism in elderly patients with lung cancer after video-assisted thoracic surgery（VATS）. Methods 100 elderly patients who were treated with VATS in our hospital from June 2017 to January 2019 were randomly divided into the high-dose group and the low-dose group; the low-dose group was treated with 1 μg/kg Dex intervention， and the high-dose group was treated with 2 μg/kg Dex intervention; the incidence of delirium of both groups were recorded， and the arterial qi and blood of the patients were analyzed before and after anesthesia. The patientscancer serum index（CSI） was monitored to evaluate the depth of anesthesia and the postoperative pain. Results The incidence of delirium in the high-dose group was significantly lower than that in the low-dose group， and the difference was statistically significant（P<0.05）; after anesthesia， the partial pressure of oxygen（PO2） and blood oxygen saturation of the patients in the high-dose group were higher than those in the low-dose group， the partial pressure of carbon dioxide（PCO2） was lower than that in the low-dose group， and the differences were statistically significant（P<0.05）; the CSI scores of patients in the high-dose group were significantly lower than those in the low-dose group 1 min before intubation， 3 min after intubation， at the beginning of surgery， and during severe surgical stimulation， and the differences were statistically significant（P<0.05）. At 12 h， 24 h， and 48 h after surgery， the visual analogue scale（VAS） scores of patients in the high-dose group were significantly lower than those in the low-dose group， and the differences were statistically significant（P<0.05）. Conclusion High-dose Dex for elderly patients undergoing VATS can effectively reduce the incidence of postoperative delirium and effectively increase the depth of anesthesia.

[Key words] Dexmedetomidine; Video-assisted thoracic surgery; Lung cancer; Postoperative delirium; Brain metabolism; Anesthesia depth monitoring

随着内腔镜技术的不断发展，其在临床的应用越来越广泛[1]。电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）基于内腔镜技术及电视成像技术发展而来，因具有手术时间短、创伤小、止血效果佳以及预后良好等优势而广泛用于肺疾病、自发性气胸以及食道疾病等的外科治疗中[2]。然而由于多数胸腔镜手术需对患者行单肺或双肺通气，患者极易发生低氧血症，脑氧血供给不足，从而发生谵妄等脑功能认知障碍，严重影响患者预后及生活质量[3]。VATS术后出现焦虑、注意力下降、智力退化及精神错乱等并发症，多发于高龄患者[4]。因此需求高效预防高龄患者VATS术后并发症并改善患者脑代谢的药物具有重要意义[5]。右美托咪定（Dexmedetomidine，Dex）具有镇静止痛、稳定血流动力学及降低应激反应等作用，多项研究将其应用于调节伤害性神经递质的释放[6]。……