妇科腹腔镜手术患者应用右美托咪啶对自主神经平衡及POCD发生率的影响

目的 探讨右美托咪啶对腹腔镜手术患者自主神经平衡及术后认知功能障碍(POCD)发生率的影响.方法 选择接受腹腔镜手术治疗的152例卵巢囊肿剔除术患者进行研究,采用随机数字表法将其所有患者分为对照组与观察组,每组76例,术前给予对照组患者0.9%氯化钠溶液静脉注射,观察组患者右美托咪啶静脉注射,之后对2组患者行腹腔镜卵巢囊肿剔除术.比较2组患者手术前后心率(HR)、舒张压(DBP)、收缩压(SBP)、脑电双频指数(BIS)等一般指标变化情况;术后2组患者苏醒时间、镇静评分、舒适度评分、VAS评分情况;心率变异性(HRV)分析;术后POCD发生率以及不良反应发生情况.结果 2组切皮时和拔管时HR、SBP、DBP、BIS等差异有统计学意义(P<0.05);观察组患者Ramsay镇静评分与对照组比较明显升高(P<0.05),苏醒时间明显长于对照组(P<0.05),舒适度和VAS评分与对照组比较差异无统计学意义(P>0.05);观察组患者谵妄分级量表评分与对照组相比明显降低(P<0.05),术后POCD发生率明显低于对照组(P<0.05);观察组放气腹后5 min(T2)LF明显低于麻醉诱导前(T0)(P<0.05),对照组患者气腹后1 min(T1)LF/HF明显高于T0(P<0.05),其余指标不同时点及2组间比较差异均无统计学意义(P>0.05);观察组患者苏醒期躁动、呕吐恶心、术后疼痛等不良反应发生率均明显低于对照组患者(P<0.05).结论 右美托咪啶应用于妇科腹腔镜手术患者中可较好地抑制气腹引起的应激反应,改善交感/迷走神经平衡状态,减轻认知功能意识损害,减少POCD的发生,具有一定的神经保护作用.

Effects of dexmedetomidine on the autonomic balance and incidence rate of POCD in patients receiving gynecological laparoscopic surgery

Objective To investigate the effects of dexmedetomidine on the autonomic balance and incidence rate of postoperative cognitive dysfunction (POCD)in patients receiving gynecological laparoscopic surgery. Methods One hundred and fifty - two patients with ovarian cyst who underwent laparoscopic surgery in our hospital from January 2015 to June 2016 were randomly divided into control group (n = 76)and observation group (n = 76). Before operation the patients in control group were given 0. 9% sodium chloride solution by intravenous injection,however,the patients in observation group were given dexmedetomidine by intravenous injection,then the patients in both groups received laparoscopic ovarian cyst resection. The changes of heart rate (HR),diastolic blood pressure (DBP),systolic blood pressure (SBP)and brain electric double frequency index (BIS)before and after operation were observed and compared between two groups. Moreover the consciousness recovery time,sedation score,comfort degree score,VAS score,heart rate variability,incidence rates of POCD and adverse reactions were observed and analyzed. Results During skin incision and extubation after surgery,there were significant differences in HR,SBP,DBP,BIS between two groups (P < 0. 05). The Ramsay sedation scores in observation group were significantly higher than those in control group (P < 0. 05),and the consciousness recovery time in observation group was significantly longer than that in control group (P < 0. 05),however,there were no significant differences in comfort degree scores and VAS scores between two groups (P > 0. 05). The incidence rates of POCD in observation group were significantly lower than those in control group (P < 0. 05),moreover DRS scores in observation group were significantly lower than those in control group (P < 0. 05). The LF at T2 in observation group was significantly lower than that at T0 (P < 0. 05),and LF/ HF at T1 in control group was significantly higher than that at T0 (P < 0. 05),but there were no significant differences in the other indexes between two groups (P > 0. 05). The incidence rates of agitation,nausea,postoperative pain and the other adverse reactions in observation group were significantly lower than those in control group (P < 0. 05 ). Conclusion The dexmedetomidine can effectively inhibit the stress response caused by pneumoperitoneum during gynecological laparoscopic surgery,which can improve the sympathetic and vagal balance,relieve the cognitive function consciousness impairment and decrease the incidence rate of POCD,with a certain nerve protection effects.