不同剂量右美托咪定联合地佐辛对胸腔镜肺癌根治术患者术后疼痛和认知功能的影响

doi:10.3969/j.issn.1671-7171.2024.12.003

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1265 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要【目的】探讨不同剂量右美托咪定(Dex)联合地佐辛对胸腔镜肺癌根治术患者术后疼痛和认知功能的影响。【方法】 122例肺癌患者,随机分为观察组和对照组,每组61例。观察组予以高剂量(1.2 μg/kg)Dex联合地佐辛麻醉,对照组予以低剂量(0.8 μg/kg)Dex联合地佐辛麻醉。比较两组患者麻醉不同时刻血流动力学指标水平、术后疼痛评分、术后炎症因子[肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)]水平、术后认知功能及不良反应发生情况。【结果】麻醉前(T₀)、术中气管导管拔除即刻(T₁)及术毕(T₂)时,两组血氧饱和度(SpO₂)水平比较,差异均无统计学意义(P>0.05);T₁、T₂时,两组心率(HR)、平均动脉压(MAP)均低于T₀时(P<0.05),且观察组低于对照组(P<0.05)。两组患者术后6 h及12 h疼痛评分均低于术后1 h(P<0.05),术后12 h疼痛评分均低于术后6 h(P<0.05);且观察组术后1 h、6 h及12 h疼痛评分均低于对照组(P<0.05)。术后,两组患者TNF-α及IL-6水平均低于术前(P<0.05),且观察组低于对照组(P<0.05)。两组患者术前及术后72 h认知功能评分比较,差异均无统计学意义(P>0.05);两组患者术后72 h认知功能评分均高于术前(P<0.05)。两组术后不良反应总发生率比较,差异无统计学意义(P>0.05)。【结论】高剂量Dex联合地佐辛用于胸腔镜肺癌根治术麻醉中,较低剂量更有利于降低患者术后疼痛水平及炎症反应程度,对认知功能的损害较小。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	杨煜
	刘岷
	朱芩芩

关键词 ：肺肿瘤, 胸腔镜检查, 右美托咪定, 环烷类, 疼痛,手术后, 认知

Abstract：【Objective】 To investigate the effects of different doses of dexmedetomidine (Dex) combined with dezocine on postoperative pain and cognitive function in patients undergoing thoracoscopic lung cancer radical surgery. 【Methods】A total of 122 lung cancer patients were randomly divided into the observation group and the control group, with 61 cases in each group. The observation group received high-dose (1.2 μg/kg) Dex combined with dezocine anesthesia, while the control group received low-dose (0.8 μg/kg) Dex combined with dezocine anesthesia. The hemodynamic levels at different anesthesia time points, postoperative pain responses, levels of inflammatory factors [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] after surgery, postoperative cognitive function, and incidence of adverse reactions were compared between the two groups. 【Results】 At pre-anesthesia (T₀), immediately after endotracheal extubation (T₁), and postoperatively (T₂), there were no statistically significant differences in oxygen saturation (SpO₂) levels between the two groups (P>0.05). At T₁,T₂, both heart rate (HR) and mean arterial pressure (MAP) levels in both groups were lower than at T₀ (P<0.05), and the observation group was lower than the control group (P<0.05). The pain scores at 6 hours and 12 hours postoperatively were lower than at 1 hour postoperatively in both groups (P<0.05), and the pain scores at 12 hours postoperatively were lower than at 6 hours postoperatively (P<0.05). Additionally, the observation group had lower pain scores at 1 hour, 6 hours, and 12 hours postoperatively compared to the control group (P<0.05). Postoperatively, TNF-α and IL-6 levels in both groups were lower than preoperatively (P<0.05), and the observation group was lower than the control group (P<0.05). There were no statistically significant differences in cognitive function scores between the two groups at 72 hours postoperatively compared to preoperatively (P>0.05). Cognitive function levels in both groups were higher at 72 hours postoperatively compared to preoperatively (P<0.05). 【Conclusion】 High-dose Dex combined with dezocine used in anesthesia for thoracoscopic lung cancer radical surgery is more advantageous in reducing postoperative pain levels and inflammation compared to low-dose Dex, minimizing cognitive function impairment with good safety.

Key words： Lung Neoplasms Thoracoscopy Dexmedetomidine Cycloparaffins Pain,Postoperative Cognition

收稿日期: 2023-06-19

中图分类号:

R734.2

引用本文:

杨煜, 刘岷, 朱芩芩. 不同剂量右美托咪定联合地佐辛对胸腔镜肺癌根治术患者术后疼痛和认知功能的影响[J]. 医学临床研究, 2024, 41(12): 1833-1835.
YANG Yu, LIU Min, ZHU Qinqin. Effects of Different Doses of Dexmedetomidine Combined with Dezocine on Postoperative Pain and Cognitive Function in Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery. JOURNAL OF CLINICAL RESEARCH, 2024, 41(12): 1833-1835.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2024.12.003 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2024/V41/I12/1833

[1] JANNU V. Effect of intraoperative dexmedetomidine on postoperative pain and pulmonary function following video-assisted thoracoscopic surgery[J].Anesth Essays Res,2020,14(1):68-71.
[2] 王乐,闻庆平,苗壮,等. 右美托咪定联合酮咯酸氨丁三醇对胸腔镜肺癌根治术术后患者疼痛及免疫功能的影响[J].中国医科大学学报,2019,48(9):794-800.
[3] 杨全全,刘政,雍文成,等. 右美托咪啶对老年胸腔镜肺癌根治术患者免疫功能、血流动力学及应激反应的影响[J].海南医学院学报,2019,25(20):1581-1584.
[4] 中华医学会,中华医学会肿瘤学分会,中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2019版)[J].中华肿瘤杂志,2020,42(4):257-287.
[5] GAWEDA B, BORYS M, BELINA B, et al. Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair:a randomized controlled trial[J].BMC Anesthesiol,2020,20(1):51.
[6] PARK J, CHOI H, JANG J W, et al. Validation of a new screening tool for dementia: the simple observation checklist for activities of daily living[J].J Clin Neurol,2021,17(1):106-112.
[7] HUYAN T, HU X J, PENG H R, et al. Perioperative dexmedetomidine reduces delirium in elderly patients after lung cancer surgery[J].Psychiatr Danub,2019,31(1):95-101.
[8] 袁琳,梁培,夏洪韬,等. 不同剂量右美托咪定复合舒芬太尼对肺癌根治术后患者炎性细胞因子和认知功能的影响[J].现代生物医学进展,2019,19(7):1357-1361.
[9] 吴婷婷,王国强. 地佐辛复合右美托咪定麻醉与老年肺癌患者术后心电图监测结果、血清MDA水平及T淋巴细胞亚群的关系[J].中国老年学杂志,2020,40(8):1643-1647.
[10] ZHOU Z G, LIU R, TAN H L, et al. The application of dexmedetomidine combined with dezocine in thoracoscopic radical resection of lung cancer and its effect on awakening quality of patients[J].Eur Rev Med Pharmacol Sci,2019,23(17):7694-7702.
[11] 李国利,高晓茹,王暐,等. 右美托咪定复合舒芬太尼对肺癌患者术后镇痛效果及细胞免疫功能的影响[J].天津医药,2020,48(5):396-401.
[12] 武长君,钱鹏. 右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对Toll样受体4/核因子-κB信号通路的影响[J].安徽医药,2021,25(6):1246-1250.
[13] 邱郁薇,赵政政,吴镜湘,等. 复合右美托咪定或硬膜外阻滞对全身麻醉下胸腔镜肺癌手术患者围手术期炎性因子的影响[J].国际麻醉学与复苏杂志,2020,41(1):43-47.
[14] 郭盟迪,张璇,寇立华,等. 右美托咪定对胸腔镜下肺癌根治术后患者血清炎症因子水平与肺部感染发生率的影响[J].广西医学,2021,43(5):534-536.