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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

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

    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。

     

    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.

     

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