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右美托咪定对睡眠障碍老年肝肿瘤切除术患者术后谵妄的影响
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| 篇名： | 右美托咪定对睡眠障碍老年肝肿瘤切除术患者术后谵妄的影响 |
| TITLE： | Effects of Dexmedetomidine on Postoperative Delirium in Liver Tumor Resection Elderly Patients with Sleep Disorders |
| 摘要： | 目的：探讨右美托咪定对睡眠障碍（SD）老年肝肿瘤切除术患者术后谵妄（POD）的影响。方法：选择2020年1月1日－2020年10月31日于郑州大学附属肿瘤医院择期行肝肿瘤切除术且术前匹兹堡睡眠质量指数（PSQI）评分≥7分的患者80例，采用随机数字表法将其分为SD组和Dex组，每组40例；同期选择术前PSQI评分＜7分的患者40例，作为C组。麻醉诱导前30min，Dex组患者静脉泵注盐酸右美托咪定注射液0.4μg/kg；3组患者均以依托咪酯乳状注射液+枸橼酸舒芬太尼注射液+罗库溴铵注射液行麻醉诱导，以丙泊酚中/长链脂肪乳注射液+注射用盐酸瑞芬太尼行维持麻醉。记录3组患者术中药物使用情况，手术时间、术后恢复室（PACU）停留时间和术后住院时间，评价其术前2h和术后1、3、5、7d时的认知功能，观察其POD的发生情况，检测其术前2h以及术后2h和1、3、5d的血浆白细胞介素6（IL-6）、中枢神经特异性蛋白S100β水平，并记录不良反应发生情况。结果：3组患者术中用药情况、手术时间比较，差异均无统计学意义（P＞0.05）。SD组、Dex组患者PACU停留时间、POD总发生率、POD持续时间均显著高于或长于C组，而Dex组显著低于或短于SD组（P＜0.05）；SD组患者术后住院时间均显著长于C组和Dex组（P＜0.05），而Dex组与C组比较差异无统计学意义（P＞0.05）。术前，3组患者的简易智力状态检查量表（MMSE）评分，血浆中IL-6、S100β水平比较，差异均无统计学意义（P＞0.05）。C组患者术后1、3d时、SD组和Dex组患者术后1、3、5、7d时的MMSE评分均显著低于同组术前，SD组和Dex组患者术后1、3、5、7d的MMSE评分均显著低于同期C组，而Dex组显著高于同期SD组（P＜0.05）；不同时间点的血浆中IL-6、S100β水平均显著高于同组术前，SD组和Dex组患者均显著高于同期C组，而Dex组显著低于同期SD组（P＜0.05）。3组患者的不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论：SD可能促进老年肝肿瘤切除术患者POD的发生，右美托咪定可以降低术前存在SD老年患者的POD发生率，可能与其可抑制IL-6、S100β的表达、减轻脑组织损伤有关，且安全性较好。 |
| ABSTRACT： | OBJECTIVE：To investigate the effects of d exmedetomidine on postoperative delirium （POD） in liver tumor resection elderly patients with sleep disorder （SD）. METHODS ：Totally 80 patients undergoing liver tumor resection with preoperative Pittsburgh sleep quality index （PSQI）score ≥7 were selected from the Affiliated Cancer Hospital of Zhengzhou University from Jan. 1st，2020 to Oct. 31st，2020. They were randomly divided into group SD and group Dex according random number table ，with 40 cases in each group. At the same time ，40 patients with preoperative PSQI score ＜7 were selected as group C. Thirty min before anesthesia induction ，Dexmedetomidine hydrochloride injection 0.4 μg/kg was injected intravenously in group Dex. Etomidate emulsion injection ，Sufentanil citrate injection and Rocuronium bromide injection were used for anesthesia induction in 3 groups，and Ropofol medium/long chain fat emulsion injection + Remifentanil hydrochloride for injection was used to maintain anesthesia. The drug use ，operation time ，PACU stay time and postoperative hospital stay were recorded in 3 groups. The cognitive function was evaluated 2 h before operation and 1，3，5，7 days after operation. The occurrence of POD was observed. The plasma levels of IL- 6 and S 100β were measured 2 h before operation ，2 h after operation ，1，3，5 days after operation. The occurrence of ADR was recorded. RESULTS ：There was no statisti cal significance in intraoperativ e drug use and operation time among 3 groups （P＞0.05）. The PACU stay time ， the incidence of POD and the duration of POD in group SD an d lixxi18@126.com group Dex were significantly higher or longer than group C ， while the Dex group was significantly lower or shorter thangroup SD （P＜0.05）. The postoperative hospitalization stay ofgroup SD was significantly longer than group C and group Dex （P＜0.05），and there was no statistical significance between group Dex and group C （P＞0.05）. Before operation ，there was no statistical significance in MMSE scores or plasma levels of IL- 6 and S100β among 3 groups（P＞0.05）. MMSE scores of group C 1，3 days after operation ，those of group SD and group Dex 1，3，5 and 7 days after operation were significantly lower than those before operation. MMSE scores of group SD and group Dex 1，3，5 and 7 days after operation were significantly lower than group C at corresponding period ；the group Dex was significantly higher than the group SD at corresponding period （P＜0.05）. The plasma levels of IL- 6 and S 100 β at different time points were significantly higher than before operation ，and the group SD and group Dex were significantly higher than the group C ，and the group Dex was significantly lower than group SD at corresponding period （P＜0.05）. There was no statistical significance in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：SD can promote the occurrence of POD in liver tumor resection elderly patients. Dexmetomidine can reduce the incidence of POD in elderly patients with preoperative SD ，the mechanism of which may be associated with the inhibition of IL- 6 and S 100β expression and the alleviation of brain injury with good safety. |
| 期刊： | 2021年第32卷第14期 |
| 作者： | 李晓曦，李亚琦，缪长虹，卢锡华，李长生 |
| AUTHORS： | LI Xiaoxi，LI Yaqi，MIAO Changhong，LU Xihua，LI Changsheng |
| 关键字： | 睡眠障碍；老年患者；肝肿瘤切除术；术后谵妄；认知功能障碍；右美托咪定 |
| KEYWORDS： | Sleep disorders ；Elderly patients ；Liver tumor resection ；Postoperative delirium ；Neurocognitive disorders ； |
| 阅读数： | 210 次 |
| 本月下载数： | 4 次 |
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