右美托咪定不同给药方式对老年结直肠癌患者术后围术期指标的影响

邵刚; 齐瑞华; 臧洪城; 叶旭琴

doi:10.16766/j.cnki.issn.1674-4152.001918

右美托咪定不同给药方式对老年结直肠癌患者术后围术期指标的影响

doi: 10.16766/j.cnki.issn.1674-4152.001918

1.
杭州市富阳区第一人民医院麻醉科，浙江杭州 311400
2.
杭州市富阳区第一人民医院肛肠外科，浙江杭州 311400

基金项目:

浙江省医药卫生科技计划项目 2018KY659

详细信息

通讯作者:
邵刚，E-mail：shaogang435@163.com

中图分类号: R614.24 R735.3
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- 被引次数: 0
出版历程
- 收稿日期: 2020-05-08
- 网络出版日期: 2022-02-16

Effect of different administration methods of dexmedetomidine on perioperative indexes in elderly patients with colorectal cancer

1.
Department of Anesthesiology, the First People's Hospital of Fuyang District, Hangzhou, Zhejiang 311400, China

摘要

摘要: 目的探究并分析右美托咪定不同给药方式联合腹横肌平面阻滞(transversus abdominis plane，TAP)对老年结直肠癌根治术患者术后苏醒以及免疫功能的影响。方法选取2018年6月—2019年6月杭州市富阳区第一人民医院收治的95例老年结直肠癌根治术患者，按照随机数字表法将其分为观察组(48例)和对照组(47例)。观察组患者右美托咪定在TAP阻滞中给予，对照组患者麻醉诱导前静脉给予负荷量。观察2组患者一般资料、手术前后血流动力学参数(HR、MAP、SpO₂)、苏醒期间SAS评分(Riker镇静和躁动评分)、苏醒期恢复情况、术后疼痛评分、免疫指标(CD4⁺、CD8⁺、CD4⁺/CD8⁺)。结果拔管时2组患者HR及MAP显著高于手术结束时(均P < 0.05)；观察组患者睁眼时、拔管时、拔管后30 min躁动评分明显低于对照组(均P < 0.05)；观察组患者自主呼吸恢复时间、睁眼时间以及拔管时间均明显短于对照组(均P < 0.05)；术后1、3 d 2组患者VAS评分较术后6 h明显降低，观察组患者术后1、3 d VAS评分显著低于对照组(均P < 0.05)；观察组术后CD4⁺、CD8⁺、CD4⁺/CD8⁺水平显著高于对照组，差异有统计学意义(均P < 0.05)。结论右美托咪定局部用药联合TAP阻滞相对于静脉用药联合TAP阻滞更能有效缩短患者苏醒时间，改善患者术后免疫功能，值得临床推广。
- 免疫功能 /
- 苏醒期躁动 /
- 腹横肌平面阻滞 /
- 右美托咪定
Abstract: Objective To investigate and analyze the effect of different administration methods of dexmedetomidine combined with transverse abdominal plane (TAP) block on the recovery and immune function of elderly patients after radical resection of colorectal cancer. Methods Total 95 elderly patients with colorectal cancer undergoing radical surgery admitted to the First People's Hospital of Fuyang District from June 2018 to June 2019 were divided into observation group (48 cases) and control group (47 cases) according to the random number table method. The patients in the observation group were given dexmedetomidine in TAP block, and the patients in the control group were given intravenous load before anesthesia induction. The general data, hemodynamic parameters (HR, MAP, SpO₂), SAS score (Riker sedation and agitation score), recovery during recovery, postoperative pain score, and immune index (CD4⁺, CD8⁺, CD4⁺/CD8⁺) were observed. Results The HR and MAP of the two groups at extubation were significantly higher than those at the end of operation (all P < 0.05). The restlessness scores at eye opening, extubation and 30 min after extubation in the observation group were significantly lower than those in the control group (all P < 0.05). The recovery time of spontaneous breathing, eye opening time and extubation time in the observation group were significantly lower than those in the control group (all P < 0.05). The VAS scores of the two groups on the 1st and 3rd day after operation were 6. The VAS score of the observation group were significantly lower than that of the control group at 1 d and 3 d after operation (all P < 0.05). The levels of CD4⁺, CD8⁺, CD4⁺/CD8⁺ in the observation group were significantly higher than those in the control group (all P < 0.05). Conclusion Dexmedetomidine combined with TAP block is more effective than intravenous drug combined with TAP block in shortening the recovery time and improving the postoperative immune function of patients, which is worthy of clinical promotion.
- Immune function /
- Restlessness in recovery period /
- Transversus abdominis plane block /
- Dexmedetomidine

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表 1 2组老年结直肠癌根治术患者一般资料比较(x±s)

组别	例数	年龄(岁)	性别(男/女，例)	出血量(mL)	尿量(mL)	BMI	补液量(mL)	手术时间(min)
对照组	47	67.23±5.34	30/17	132.31±13.13	439.22±92.13	24.28±2.23	1 562.33±476.21	144.62±25.41
观察组	48	67.54±5.25	29/19	131.25±14.23	443.33±93.21	24.31±2.19	1 564.46±471.44	146.12±25.53
统计量		0.843^a	0.118^b	0.414^a	0.495^a	0.582^a	0.631^a	0.782^a
P值		0.372	0.732	0.513	0.152	0.732	0.372	0.263
注：^a为t值，^b为χ²值。

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表 2 2组老年结直肠癌根治术患者HR、SpO₂、MAP比较(x±s)

组别	例数	HR(次/min)				F值	P值
组别	例数	术前	手术结束时	拔管时	拔管后30 min	F值	P值
观察组	48	81.12±6.21	71.13±6.23^a	88.13±5.21^b	80.12±5.12^bc	71.463	< 0.001
对照组	47	82.18±6.26	72.25±6.19^a	88.21±5.14^b	81.23±4.98^bc	63.279	< 0.001
t值		0.829	0.879	0.075	1.071
P值		0.410	0.382	0.940	0.287

组别	例数	SpO₂(%)				F值	P值
组别	例数	术前	手术结束时	拔管时	拔管后30 min	F值	P值
观察组	48	99.70±0.53	99.24±0.54	98.24±0.64	99.53±0.57	2.677	0.508
对照组	47	99.72±0.52	99.27±0.57	98.26±0.66	99.61±0.54	2.842	0.622
t值		0.186	0.263	0.150	0.702
P值		0.853	0.793	0.881	0.484

组别	例数	MAP(mm Hg)				F值	P值
组别	例数	术前	手术结束时	拔管时	拔管后30 min	F值	P值
观察组	48	84.13±4.21	74.19±4.21^a	89.32±4.12^b	80.19±4.52^bc	107.530	< 0.001
对照组	47	83.15±4.13	75.23±4.12^a	87.83±4.23^b	81.23±4.43^c	71.521	< 0.001
t值		1.145	1.271	1.739	1.132
P值		0.255	0.227	0.085	0.260
注：与同组术前比较，^aP < 0.05；与同组手术结束时比较，^bP < 0.05；与同组拔管时比较，^cP < 0.05。

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表 3 2组老年结直肠癌根治术患者苏醒期间SAS评分比较(x±s，分)

组别	例数	手术后SAS评分			F值	P值
组别	例数	睁眼时	拔管时	拔管后30 min	F值	P值
观察组	48	4.34±0.58	5.03±0.51^a	3.78±0.54^ab	63.569	< 0.001
对照组	47	5.05±0.54	5.45±0.59^a	4.23±0.54^ab	71.385	< 0.001
t值		5.424	7.312	6.573
P值		0.038	0.035	0.012
注：与睁眼时比较，^aP < 0.05；与拔管时比较，^bP < 0.05。

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表 4 2组老年结直肠癌根治术患者苏醒期情况比较(x±s，min)

组别	例数	麻醉恢复情况
组别	例数	自主呼吸恢复时间	睁眼	拔管
观察组	48	8.34±2.26	13.67±2.34	13.13±2.25
对照组	47	13.43±2.45	16.46±2.31	17.31±2.23
t值		6.313	5.452	9.734
P值		0.021	0.031	0.012

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表 5 2组老年结直肠癌根治术患者术后VAS评分比较(x±s)

组别	例数	VAS评分			F值	P值
组别	例数	术后6 h	术后1 d	术后3 d	F值	P值
观察组	48	3.12±0.51	2.46±0.37^a	1.65±0.41^ab	138.121	< 0.001
对照组	47	3.87±0.45	3.21±0.38^a	2.31±0.42^ab	165.229	< 0.001
t值		5.843	7.263	6.672
P值		0.034	0.029	0.011
注：与术后6 h比较，^aP < 0.05；与术后1 d比较，^bP < 0.05。

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表 6 2组老年结直肠癌根治术患者CD4⁺、CD8⁺、CD4⁺/CD8⁺比较(x±s)

组别	例数	CD4⁺(%)			F值	P值
组别	例数	术前	术后1 d	术后3 d	F值	P值
观察组	48	41.43±4.56	34.45±5.36^a	28.12±5.36^ab	81.559	< 0.001
对照组	47	41.35±4.76	30.04±5.35^a	23.56±5.32^ab	143.699	< 0.001
t值		1.203	5.832	7.843
P值		0.782	0.029	0.018

组别	例数	CD8⁺(%)			F值	P值
组别	例数	术前	术后1 d	术后3 d	F值	P值
观察组	48	35.23±4.54	31.53±4.76^a	27.25±4.78^ab	34.732	< 0.001
对照组	47	35.31±4.67	27.65±4.87^a	22.34±4.54^ab	90.644	< 0.001
t值		1.932	5.481	7.831
P值		0.743	0.028	0.020

组别	例数	CD4⁺/CD8⁺(%)			F值	P值
组别	例数	术前	术后1 d	术后3 d	F值	P值
观察组	48	1.25±0.34	1.22±0.22^a	1.01±0.21^ab	11.839	< 0.001
对照组	47	1.31±0.36	1.02±0.22^a	0.79±0.19^ab	44.718	< 0.001
t值		1.139	5.038	7.832
P值		0.832	0.032	0.028
注：与术前比较，^aP < 0.05；与术后1 d比较，^bP < 0.05。

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