CAJ | 학술논문

目的：观测不同剂量右美托咪定（Dex）对老年患者腹腔镜下结直肠癌手术术后早期认知功能障碍（POCD）的影响。方法选择全麻下拟行腹腔镜下结直肠癌手术的老年患者80例，年龄65岁以上，男性47例，女性33例，患者ASAⅠ~Ⅲ级。采用随机数字表法，随机分为4组（n=20）：对照组（C组），低剂量组（D1组），中剂量组（D2组），高剂量组（D3组）。D1组、D2组和D3组在麻醉诱导前均给予右美托咪定负荷剂量0.5μg/kg，输注时间15 min，在气管插管后分别以0.2、0.5、0.8μg· kg-1· h-1持续泵注Dex，手术结束前40 min停止输注；对照组（C组）以相同方法静脉给予等容量0.9%氯化钠注射液。记录手术时间、术中和恢复期不良反应发生情况、术毕到恢复自主呼吸时间（TR）、自主呼吸到睁眼时间（TO）、睁眼到拔除气管导管时间（TE）。4组患者进行手术前1 d、手术后1 d与手术后3 d行简易智力状态检查法（MMSE）评分，计算出患者手术后1 d和3 d POCD的发生率。结果与C组、D1组比较，D2组、D3组术后POCD的发生率下降，比较差异有统计学意义（P<0.05）。与C组、D1组、D2组比较，D3组术中低血压，心动过缓发生率升高，苏醒时间延长，比较差异有统计学意义（P<0.05）。结论麻醉诱导前给予Dex0.5μg/kg，术中以0.5、0.8μg· kg-1· h-1的速率输注能降低老年患者腹腔镜下结直肠癌手术术后早期POCD的发生率。以0.5μg· kg-1· h-1的速率输注Dex效果好，副作用少。
목적：관측불동제량우미탁미정（Dex）대노년환자복강경하결직장암수술술후조기인지공능장애（POCD）적영향。방법선택전마하의행복강경하결직장암수술적노년환자80례，년령65세이상，남성47례，녀성33례，환자ASAⅠ~Ⅲ급。채용수궤수자표법，수궤분위4조（n=20）：대조조（C조），저제량조（D1조），중제량조（D2조），고제량조（D3조）。D1조、D2조화D3조재마취유도전균급여우미탁미정부하제량0.5μg/kg，수주시간15 min，재기관삽관후분별이0.2、0.5、0.8μg· kg-1· h-1지속빙주Dex，수술결속전40 min정지수주；대조조（C조）이상동방법정맥급여등용량0.9%록화납주사액。기록수술시간、술중화회복기불량반응발생정황、술필도회복자주호흡시간（TR）、자주호흡도정안시간（TO）、정안도발제기관도관시간（TE）。4조환자진행수술전1 d、수술후1 d여수술후3 d행간역지력상태검사법（MMSE）평분，계산출환자수술후1 d화3 d POCD적발생솔。결과여C조、D1조비교，D2조、D3조술후POCD적발생솔하강，비교차이유통계학의의（P<0.05）。여C조、D1조、D2조비교，D3조술중저혈압，심동과완발생솔승고，소성시간연장，비교차이유통계학의의（P<0.05）。결론마취유도전급여Dex0.5μg/kg，술중이0.5、0.8μg· kg-1· h-1적속솔수주능강저노년환자복강경하결직장암수술술후조기POCD적발생솔。이0.5μg· kg-1· h-1적속솔수주Dex효과호，부작용소。
Objective To investigate the effect of different doses of dexmedetomidine (Dex) on early postoperative cognitive dysfunction in elderly patients undergoing laparoscopic surgery for colorectal cancer. Methods Eighty ASAI-III elderly patients (over 65 years) were randomized equally into 4 groups including a control group without dexmedetomidine and 3 dexmedetomidine groups (groups D1, D2, and D3) with loading dexmedetomidine doses of 0.2, 0.5, and 0.8 μg/kg and maintenance doses of 0.2, 0.5, and 0.8μg · kg-1 · h-1, respectively. Dex was discontinued 30 min before the end of surgery. The time of operation, adverse reactions, time from the end of surgery to spontaneous breathing recovery (TR), time from spontaneous breathing recovery to opening eyes (TO), and time from opening eyes to extubation (TE) were recorded. Mini-Mental State (MMSE) test was used to assess the cognitive function 1 day before and at 1 day and 3 days after the operation. Results The incidence of postoperative cognitive dysfunction (POCD) was significantly lower in groups D2 and D3 than in the control group and group D1 (P<0.05). The incidences of hypotension and bradycardia were the highest in group D3 (P<0.05), which also had longer significantly TO and TE than the other 3 groups (P<0.05). Conclusion Dexmedetomidine with a loading dose of 0.5 μg/kg followed by maintenance doses of 0.5 and 0.8 μg · kg-1 · h-1 (preferentially 0.5 μg · kg-1 · h-1) can reduce the incidence of POCD in elderly patients undergoing laparoscopic surgery for colorectal cancer.