CAJ | 학술논문

目的：探讨右美托咪定对老年患者腹腔镜卵巢癌根治术后苏醒与认知功能的影响。方法选取2010年10月至2013年12月行腹腔镜卵巢癌根治术的老年患者134例，采用随机数字表法分为两组，67例患者行右美托咪定泵注为观察组，67例患者行生理盐水泵注为对照组，采用简易精神状态量表（MMSE）评定患者的认知功能，比较两组患者相关临床指标的改变情况、术后苏醒时间、苏醒期的躁动情况、认知功能状况、不良反应情况。结果观察组患者心率、平均动脉压、中心静脉压、心输出量、肾上腺素、去甲肾上腺素变化平稳，未见明显波动。对照组患者心率、平均动脉压、心输出量、肾上腺素、去甲肾上腺素在T1时均显著升高。对照组患者中心静脉压在T1时显著降低。观察组患者在T1、T2、T3、T4时心率、平均动脉压、心输出量、肾上腺素、去甲肾上腺素均明显低于对照组。观察组患者在T1、T2、T3、T4时中心静脉压明显高于对照组。观察组患者躁动发生率、躁动评分、不良反应发生率均明显低于对照组，观察组患者躁动评级明显好于对照组，差异均有统计学意义（P<0.05）。两组患者认知功能评分在Tb时均显著降低，在Td时均恢复正常。结论右美托咪定有助于稳定血流动力学指标，预防苏醒期躁动，但可能造成苏醒延迟，对老年患者腹腔镜卵巢癌根治术后认知功能无明显影响，不良反应少，具有较高的安全性，值得临床推广使用。
목적：탐토우미탁미정대노년환자복강경란소암근치술후소성여인지공능적영향。방법선취2010년10월지2013년12월행복강경란소암근치술적노년환자134례，채용수궤수자표법분위량조，67례환자행우미탁미정빙주위관찰조，67례환자행생리염수빙주위대조조，채용간역정신상태량표（MMSE）평정환자적인지공능，비교량조환자상관림상지표적개변정황、술후소성시간、소성기적조동정황、인지공능상황、불량반응정황。결과관찰조환자심솔、평균동맥압、중심정맥압、심수출량、신상선소、거갑신상선소변화평은，미견명현파동。대조조환자심솔、평균동맥압、심수출량、신상선소、거갑신상선소재T1시균현저승고。대조조환자중심정맥압재T1시현저강저。관찰조환자재T1、T2、T3、T4시심솔、평균동맥압、심수출량、신상선소、거갑신상선소균명현저우대조조。관찰조환자재T1、T2、T3、T4시중심정맥압명현고우대조조。관찰조환자조동발생솔、조동평분、불량반응발생솔균명현저우대조조，관찰조환자조동평급명현호우대조조，차이균유통계학의의（P<0.05）。량조환자인지공능평분재Tb시균현저강저，재Td시균회복정상。결론우미탁미정유조우은정혈류동역학지표，예방소성기조동，단가능조성소성연지，대노년환자복강경란소암근치술후인지공능무명현영향，불량반응소，구유교고적안전성，치득림상추엄사용。
Objective To investigate influence of dexmedetomidine on postoperative awakening and cognitive function in elderly patients with laparoscopic resection of ovarian cancer. Methods 134 elderly patients with laparoscopic resection of ovarian cancer were selected in hospital from October 2010 to December 2013,who were randomly divided into two groups.67 patients treated dexmedetomidine infusion as observation group. 67 patients treated saline infusion as control group. Cognitive function was evaluated by mini mental state examination (MMSE). Changes of related clinical indexes,postoperative awaken time,agitation during awaken period,cognitive function,adverse reactions were compared between two groups. Results Changes of HR,MAP,CVP,CO,epinephrine,norepinephrine in observation group were smooth,which had no obvious fluctuation. In control group,HR,MAP,CO,epinephrine,norepinephrine increased significantly at T1,while CVP decreased significantly at T1. HR,MAP,CO,epinephrine,norepinephrine at T1,T2,T3,T4 in observation group were significantly lower than control group. CVP at T1, T2,T3,T4 in observation group were significantly higher than control group.Incidence of agitation,agitation score,incidence of adverse reactions in observation group were significantly lower than control group. Agitation rating in observation group was significantly better than control group. Differences were statistically significant (P<0.05). Cognitive function score decreased significantly at Tb,while restored to normal at Td in two groups. Conclusions Dexmedetomidine helps to stabilize hemodynamics,which can prevention agitation during awaken period. Dexmedetomidine may cause awareness delay,which has no significant influence on cognitive function in elderly patients with laparoscopic resection of ovarian cancer. Dexmedetomidine has less adverse reaction and high security,which is worthy of clinical use.