右美托咪定复合乌司他丁对老年胃肠肿瘤切除术患者术后谵妄的影响

目的观察右美托咪定复合乌司他丁对老年患者行腹腔镜下胃肠肿瘤切除手术术后谵妄(POD)的影响。方法选择2015年9月至2016年1月择期行腹腔镜下胃肠肿瘤切除术患者180例,男97例,女83例,年龄65~80岁,ASAⅡ或Ⅲ级,采用随机数字表法随机分为四组:右美托咪定组(D组)、乌司他丁组(U组)、右美托咪定+乌司他丁组(DU组)和生理盐水组(C组),每组45例。麻醉诱导前,D组给予右美托咪定负荷剂量0.5μg/kg,输注15min后以0.3μg·kg~(-1)·h~(-1)持续泵注,手术结束前40min停止输注;U组静注乌司他丁10 000U/kg,15~20min内完成;DU组先静注乌司他丁10 000U/kg,15~20min内完成,再给予右美托咪定负荷剂量0.5μg/kg,输注15min后以0.3μg·kg~(-1)·h~(-1)持续泵注,手术结束前40min停止输注;C组给予等容量生理盐水。记录手术时间、术中出血量、尿量和补液量;于术前1d(T0)、手术开始(切皮)后1h(T_1)、术后第1天(T_2)、术后第2天(T_3)、术后第3天(T_4)采血检测多巴胺(DA)、肾上腺素(AD)、去甲肾上腺素(NE)浓度;T_0和T_2~T_4时由精神科医师采用谵妄评定量表中文修订版(CAM-CR)对患者谵妄情况进行评估,记录谵妄的发生例数。结果与T_0时比较,T_1~T_4时U组和C组DA、AD和NE浓度明显升高,T_1时D组和DU组的DA浓度明显升高,T_1、T_2时D组和DU组的AD浓度明显升高(P0.05);T_2~T_4时D组和DU组DA和AD浓度明显低于C组和D组,T_1~T_4时D组和DU组的NE浓度明显低于C组和D组(P0.05)。D组、U组和DU组POD发生率明显低于C组(P0.05);D组、U组和DU组POD发生率差异无统计学意义。结论单独使用右美托咪定或乌司他丁可以降低老年患者腹腔镜下胃肠肿瘤切除手术POD发生率,两种药物复合使用并不能进一步降低POD发生率。

Effect of dexmedetomidine combined with ulinastatin on postoperative delirium in elderly patients under-going resection of gastrointestinal tumor

Objective To investigate the effect of dexmedetomidine combined with ulinastatin on postoperative delirium in elderly patients undergoing resection of gastrointestinal tumor. Methods A total of 180 elderly patients (97 males,83 females,aged 65-80 years,ASA grade Ⅱ orⅢ)who underwent laparoscopic surgery for gastrointestinal tumor,were randomized into four groups (n =45 each):dexmedetomidine group (group D),ulinastatin group (group U),dexmedetomidine+ulinastatin group (group DU)and control group (group C).Patients in group D were given a loading dosage of dexmedetomidine 0.5 μg/kg intravenously 1 5 min before the induction of general anesthesia,followed by a continuous infusion of 0.3 μg·kg-1 ·h-1 ,and dexmedetomidine was ad-ministered till 40 min before the end of surgery.Patients in the group U were given a loading dosage of ulinastatin 10 000 U/kg intravenously in 20 min.In group DU,dexmedetomidine and ulinastatin were administered in accordance in group D and group U respectively.Patients in group C were given 0.9% saline solution.The volume of blood loss,the time of operation and recovery,the adverse reac-tions after surgery were recorded.The concentration of dopamine (DA),adrenaline (AD),norepi-nephrine (NE)were measured within the preoperative 1 d (T0 ),within the first hour of surgery (T1 ),within the postoperative 1 d (T2 ),2 d (T3 ),3 d (T4 ).The confusion assessment method Chi-nese reversion (CAM-CR)was used to screen POD on T0 ,T2-T4 .Results The levels of DA,AD and NE in the group C and group U at T1-T4 significantly elevated than those at T0 (P <0.05);the levels of DA at T1 and the levels of AD at T1 ,T2 in group D and group DU significantly elevated than those at T0 (P <0.05).The levels of DA,AD at T3 ,T4 and the levels of NE at T1-T4 in group D and group DU were significantly reduced compared with those in the group C and group D (P <0.05 ). Compared with the group C,the incidence of POD was significantly reduced in the group D,group U and group DU (P <0.05).Among the three groups (D,U and DU),the difference were not statisti-cally significant in the incidence of POD.Conclusion Dexmedetomidine or ulinastatin may reduce the rate of POD in elderly patients undergoing laparoscopic surgery for gastrointestinal tumor.Compared with the administration of ulinastatin or dexmedetomidine alone,combined application of dexmedeto-midine and ulinastatin does not reduce the incidence of POD.