右美托咪啶对无线镇痛管理下老年胸腔镜患者术后镇痛及认知功能的影响

Impact of Dexmedetomidine on postoperative analgesia and cognitive function in elderly patients underwent thoracoscopic surgery under wireless patient controlled-analgesia*

摘要:

摘要：目的??探讨右美托咪啶对无线镇痛管理下的老年胸腔镜患者术后镇痛效果与术后认知功能的影响。方法?选取2017年1月－2018年6月该院行胸腔镜手术治疗的80例老年患者，按照随机数字法将患者随机分为右美托咪啶联合舒芬太尼D+S组（40例）和舒芬太尼S组（对照组，40例），对照组（S组）为无线镇痛泵中予以舒芬太尼，D+S组在对照组基础上联合应用右美托咪啶，比较两组患者术前术后不同时点简易精神量表（MMSE）评分、术后疼痛视觉模拟评分（VAS）、外周血白细胞介素-1（IL-1）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的表达水平以及不良反应情况。结果?D+S组与S组患者术前当天、术后5和7 d MMSE评分比较，差异无统计学意义（P >0.05），术后1和3 d，D+S组MMSE评分明显高于S组（P <0.05）；D+S组术后6和12 h疼痛VAS评分明显低于S组（P <0.05），术后24和48 h，D+S组和S组疼痛VAS评分比较，差异无统计学意义（P >0.05）；术前当天、术后5和7 d，两组患者IL-1、IL-6和TNF-α表达水平比较，差异均无统计学意义（P >0.05），术后1和3 d，IL-1、TNF-α和IL-6表达水平比较，差异均有统计学意义（P <0.05）；D+S组恶心发生率明显低于S组（P <0.05），心动过缓发生率则高于S组（P <0.05），但呕吐和尿潴留发生率比较，两组差异无统计学意义（P >0.05）。结论?右美托咪啶可有效改善无线镇痛管理下老年胸腔镜患者术后早期疼痛和认知功能，同时降低术后炎性因子水平。

Abstract:

Abstract: Objective?To evaluate the impact of Dexmedetomidine on postoperative cognitive function in elderly patients underwent thoracoscopic surgery under wireless analgesia.?Methods?80 elderly patients who underwent thoracoscopic surgery from Jan 2017 to June 2018 were randomly divided into D + S group (40 cases) and S group (40 cases). Sufentanil were added into the wireless patient controlled-analgesia pump as a controlled group. In the D + S group, Dexmedetomidine were combined with sufentanil used in the Wireless patient-controlled analgesia, and the preoperative and postoperative simple mental scale (MMSE) score, VAS scores of postoperative pain, and peripheral blood IL-1 , IL-6 and TNF-α expression levels as well as adverse reactions were compared in different time point between different groups.?Results?There was no significant difference in the MMSE scores between the D + S group on the day before surgery, at day 5 and 7 after surgery (P > 0.05). The MMSE scores in the D + S group were significantly higher than those in the S group at 1 day and 3 days after operation (P < 0.05). The VAS scores of pain on 6 h and 12 h were significantly lower than those of S group (P < 0.05). There was no significant difference in pain VAS score between the two groups 24 and 48 hours after operation (P > 0.05). The day before surgery, at day 5 and 7 after operation, there was no significant difference in the expression levels of IL-1, IL-6 and TNF-α between the two groups (P > 0.05). The expression levels of IL-1, IL-6 and TNF-α were significantly different at day 1 and 3 after operation (P < 0.05). The incidence of nausea in D + S group was significantly lower than that in S group (P < 0.05), while the incidence of bradycardia was higher than that in S group (P < 0.05), but the incidence of vomiting and urinary retention was not significantly different between the two groups (P > 0.05).?Conclusion?Dexmedetomidine can not only effectively improve postoperative pain and cognitive function in elderly patients underwent thoracoscopic, but also reduce postoperative inflammatory levels.