右美托咪定联合综合体温保护对围术期老年恶性肿瘤患者的影响

胡建; 许建峰; 邢凡; 章壮云; 卞清明; 顾连兵

doi:10.7619/jcmp.20213993

右美托咪定联合综合体温保护对围术期老年恶性肿瘤患者的影响

1.
江苏省南京市溧水区人民医院/东南大学附属中大医院溧水分院麻醉科, 江苏南京, 211200
2.
江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院麻醉科, 江苏南京, 210009

基金项目:

江苏省第五期333高层次人才项目 2018Ⅲ-0169

江苏省南京市十三五第一层次青年卫生人才项目 QRX17034

江苏大学临床医学科技发展基金项目 JLY20180214

详细信息

通讯作者:
卞清明, E-mail: bqm2518@sina.com

中图分类号: R735.3;R614
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出版历程
- 收稿日期: 2021-10-10
- 网络出版日期: 2022-03-10
- 发布日期: 2022-02-14

Effects of dexmedetomidine combined with comprehensive body temperature protection for perioperative elderly patients with malignancies

1.
Department of Anesthesiology, Lishui District People's Hospital in Nanjing of Jiangsu Province, Lishui Branch of Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, 211200
2.
Department of Anesthesiology, Jiangsu Provincial Cancer Hospital, Jiangsu Institute of Cancer Prevention and Treatment/Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210009

摘要

摘要:
目的探讨右美托咪定联合综合体温保护对老年恶性肿瘤患者术后谵妄及血清S100钙结合蛋白β(S100β)、神经元特异性烯醇化酶(NSE)水平的影响。
方法选择90例择期行外科手术治疗的恶性肿瘤患者, 随机分为对照组(C组)、体温保护组(T组)、体温保护联合右美托咪定组(T-D组)，每组30例。C组采用常规体温保护, T组和T-D组采用综合体温保护。T-D组泵注0.5 μg/kg右美托咪定, 10 min后麻醉诱导。观察并记录3组患者麻醉诱导即刻(T₀)和手术开始0.5 h(T₁)、1 h(T₂)、1.5 h(T₃)、2 h(T₄)以及术毕(T₅)鼻咽温度; 记录3组患者苏醒期躁动、寒颤及术后谵妄的发生率; 检测各组患者麻醉诱导前10 min、术后24 h、术后72 h血清S100β、NSE水平。
结果与T₀比较, C组T₁至T₅ 5个时点的鼻咽温度降低，差异有统计学意义(P < 0.05); T组、T-D组T₂至T₅ 4个时点的鼻咽温度高于C组，差异有统计学意义(P < 0.05)。T组、T-D组患者苏醒期躁动、术后谵妄及寒颤的发生率均低于C组，差异有统计学意义(P < 0.05); 与T组比较, T-D组苏醒期躁动、术后寒颤的发生率更低，差异有统计学意义(P < 0.05)。T-D组患者术后24 h、术后72 h血清S100β、NSE水平均低于C组和T组，差异有统计学意义(P < 0.05)。
结论右美托咪定联合综合体温保护能够显著降低患者血清S100β、NSE水平，并有效降低患者术后谵妄、苏醒期躁动及寒颤的发生率。
- 右美托咪定 /
- 体温保护 /
- 恶性肿瘤 /
- S100钙结合蛋白β /
- 神经元特异性烯醇化酶
Abstract:
Objective To explore the effect of dexmedetomidine combined with comprehensive body temperature protection on postoperative delirium and the levels of serum S100 beta(S100β), neuron specific enolase (NSE) in elderly patients with malignancies.
Methods A total of 90 elderly patients undergoing elective malignant tumor surgery were randomly divided into three groupscontrol group (group C, n=30), temperature protection group (group T, n=30) and temperature protection combined with dexmedetomidine group (group T-D, n=30). Routine thermal insulation in operation was adopted in the group C, while the group T and group T-D adopt comprehensive body temperature protection measures. In group T-D, dexmedetomidine was given at a dosage of 0.5 μg/kg 10 min before anesthesia induction. The nasopharyngeal temperature was recorded at induction of anesthesia (T₀), 0.5 h after operation (T₁), 1 h after operation (T₂), 1.5 h after operation (T₃), 2 h after operation (T₄) and completion of operation (T₅). The incidence of emergence agitation, chills and postoperative delirium were recorded. Serum S100β, NSE levels in three groups were measured at 10 min before induction of anesthesia, 24 h and 72 h after operation.
Results Compared with T₀, the nasopharyngeal temperatures in the group C at T₁ to T₅ time points were significantly decreased (P < 0.05), and were obviously higher in the group T and group T-D at T₂ to T₅ time points than those in the group C (P < 0.05). The incidence rates of emergence agitation, postoperative delirium and chills in the group T, group T-D were significantly lower than those in the group C (P < 0.05). Compared with the group T, the incidence rates of emergence agitation and postoperative chills were further decreased (P < 0.05). Compared with the group C and group T, serum S100β and NSE levels in the group T-D at 24 h and 72 h after operation were significantly decreased (P < 0.05).
Conclusion The combination of dexmedetomidine and comprehensive body temperature protection can obviously decrease the levels of serum S100β and NSE, and effectively reduce the incidence of postoperative delirium, emergence agitation and postoperative chills.
- dexmedetomidine /
- temperature protection /
- malignant tumor /
- S100 beta /
- neuron specific enolase

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表 1 3组患者一般资料、术中麻醉药物用量及术后疼痛评分比较(x±s)[n(%)]

组别	年龄/岁	性别		ASA分级		体质量指数/(kg/m²)	手术时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	术后24 h VAS评分/分
组别	年龄/岁	男	女	Ⅰ级	Ⅱ级	体质量指数/(kg/m²)	手术时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	术后24 h VAS评分/分
C组(n=30)	70.4±2.3	18(60.0)	12(40.0)	9(30.0)	21(70.0)	22.7±2.1	225.6±22.8	1 011.8±105.6	1 721.0±81.5	2.1±0.8
T组(n=30)	70.0±2.1	17(56.7)	13(43.3)	8(26.7)	22(73.3)	22.4±2.2	203.6±26.1	1 153.5±134.2	1 638.4±93.3	2.0±0.8
T-D组(n=30)	69.8±2.0	19(63.3)	11(36.7)	6(20.0)	24(80.0)	21.9±2.4	215.3±25.3	1 241.2±124.7	1 683.1±88.0	1.9±0.7
ASA: 美国麻醉医师协会; VAS: 视觉模拟评分法。

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表 2 3组患者不同时点鼻咽温度及SBP、DBP、HR比较(x±s)

指标	组别	T₀	T₁	T₂	T₃	T₄	T₅
鼻咽温度/℃	C组	36.4±0.3	36.2±0.3^#	35.9±0.2^#	35.7±0.2^#	35.7±0.2^#	35.5±0.2^#
	T组	36.3±0.3	36.3±0.3	36.3±0.2^*	36.4±0.2^*	36.4±0.3^*	36.4±0.3^*
	T-D组	36.4±0.4	36.4±0.2	36.4±0.3^*	36.4±0.3^*	36.5±0.3^*	36.5±0.3^*
SBP/mmHg	C组	123.4±12.2	116.3±11.3	121.0±9.6	130.8±15.3	122.7±12.8	119.6±11.4
	T组	117.2±13.8	115.2±12.9	120.1±14.8	128.2±14.3	117.2±14.6	115.4±12.6
	T-D组	119.1±13.0	110.2±16.2	115.4±10.3	125.5±10.9	120.1±15.9	118.3±10.2
DBP/mmHg	C组	83.6±5.6	85.7±7.8	84.1±5.0	78.6±7.2	80.1±6.1	78.2±5.3
	T组	81.5±6.1	84.1±8.2	79.5±6.5	81.0±8.5	82.3±7.8	79.1±6.5
	T-D组	80.4±6.7	86.9±9.6	83.2±4.7	77.5±6.6	79.0±8.4	80.3±7.3
HR/(次/min)	C组	70.1±7.3	74.3±7.2	72.6±7.8	70.6±7.4	72.3±7.2	71.6±7.0
	T组	71.4±7.1	75.2±7.1	71.5±7.9	71.8±7.9	71.7±7.8	71.1±7.1
	T-D组	69.3±7.0	73.5±7.0	70.3±7.0	70.6±7.0	70.5±7.1	70.9±7.0
SBP: 收缩压; DBP: 舒张压; HR: 心率。与C组比较, *P < 0.05; 与T₀比较, #P < 0.05。

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表 3 3组患者躁动、术后谵妄、寒颤发生情况比较[n(%)]

组别	n	苏醒期躁动	术后谵妄	术后寒颤
C组	30	6(20.0)	6(20.0)	5(16.7)
T组	30	1(3.3)^*	1(3.3)^*	1(3.3)^a
T-D组	30	0 ^*#	1(3.3)^*	0^*#
与C组比较, *P < 0.05; 与T组比较, #P < 0.05。

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表 4 3组患者各时点血清S100β、NSE水平比较(x±s)

指标	组别	诱导前10 min	术后24 h	术后72 h
S100β/(ng/L)	C组	95.7±15.5	179.5±37.2^△	151.4±32.3^△
	T组	96.9±12.9	163.5±19.8^△	140.7±14.1^△
	T-D组	98.4±13.4	137.3±12.3^*#△	116.6±16.2^*#△
NSE/(μg/L)	C组	4.5±0.9	24.3±5.2^△	16.3±3.5^△
	T组	3.9±0.9	21.9±4.3^△	13.7±2.9^△
	T-D组	4.1±0.8	15.7±3.8^*#△	8.1±1.4^*#△
S100β: 血清S100钙结合蛋白β; NSE: 神经元特异性烯醇化酶。与C组比较, *P < 0.05; 与T组比较, #P < 0.05; 与诱导前10 min比较, △P < 0.05。

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