摘要
目的 研究右美托咪定联合控制性低中心静脉压对腹腔镜肝切除手术患者术后认知功能障碍的影响,并对其可能机制进行探讨。方法 选择2017年1月-2019年5月在本院择期行腹腔镜肝切除患者90例作为研究对象,根据随机化量表分为常规补液组(C组)、控制性低中心静脉压组(L组)和右美托咪定联合控制性低中心静脉压组(D组)三组,每组各30例。C组根据经验进行输液,维持CVP范围在6~12 cm H2O,L组根据调节麻醉深度、控制液体输注量加上使用血管活性药物硝酸甘油等将CVP控制在0~5 cm H2O,使收缩压控制在大于90 mm Hg,平均动脉压大于60 mm Hg,D组在L组基础上,于麻醉诱导前给予泵注右美托咪定0.5μg/kg,10分钟后改为维持量,范围在0.3~0.5μg/(kg·h)直到术毕前30min停止泵注。记录术中出血量、手术时间、肝门阻断时间,术后1 d、3 d、7 d血肌酐、尿素氮指标,记录麻醉诱导前、术毕、术后1 d各时间点IL-6的水平,并对患者术前1 d、术后1 d、3 d、7 d进行简易智能量表MMES进行评分。结果 与C组相比,L组和D组术中出血量、手术时间、肝门阻断时间均少于C组(P<0.05);三组患者术后1 d血肌酐、尿素氮较术前偏高一点,术后3 d、7 d恢复术前水平(P> 0.05);与C组相比,L组和D组在术毕和术后1 d两个时间点IL-6水平有所降低(P<0.05);三组患者术前1 d MMES评分差异无统计学意义(P>0.05),与D组相比,C组和L组术后1 d、3 d、7 d MMES评分有所下降(P<0.05),与C组相比,L组术后1 d、3 d、7 d MMES差异无统计学意义(P>0.05)。结论 右美托咪定联合控制性低中心静脉压可有效减少腹腔镜肝切除患者出血量,对肾功能无影响,并减少患者术后认知功能发生率。
Objective To observe the effect of dexmedetomidine combined with controlled low central venous pressure on postoperative cognitive dysfunction in patients undergoing laparoscopic hepatectomy and discuss its possible mechanism.Methods Ninety cases of patients those who would receive laparoscopic hepatectomy in our hospital were selected and they were divided into routine rehydration group(C group),controlled low central venous pressure group(L group),and dexmedetomidine combined with controlled low central venous pressure group(D group)according to randomized scale,thirty cases in each group.Group C performed infusion based on experience,maintaining the CVP range from 6 to 12 cm H2 O.Group L controlled CVP between 0 and 5 cm H2 O according to regulating the depth of anesthesia,controlling the amount of liquid infusion,and using the vascular active drug nitroglycerin.The systolic pressure is controlled at greater than 90 mm Hg,the average arterial pressure is greater than 60 mm Hg,and in group D,dexmedetomidine was given at the dose of 0.5 ug/kg based on group L before the anesthesia induction.Ten minutes later,the administration of dexmedetomidine changed into maintenance dose ranging from 0.3 to 0.5μg/(kg·h)until 30 minutes before surgery and then stopped the pump injection.The amount of bleeding during surgery,the time of operation,the time of hepatic portal obstruction,and postoperative blood creatinine and urea nitrogen(1 st,2 nd,and 3 rdday after operation)were recorded.The levels of IL-6 at the time points before anaesthesia induction,completion of surgery,and first day after surgery were recorded as well.The patients were rated with simple mental energy meter MMES scores on the first day,the second day and the seventh day after operation.Results The bleeding volume,operation time,and hepatic occlusion time in groups L and D were all less than those in group C(P<0.05).Postoperative blood creatinine and urea nitrogen were higher than those before operative in the three groups,and those restored to preoperative levels on the third day and seventh day(P>0.05).Compared with group C,the level of IL-6 in group L and group D decreased at the complete of surgery and one day after surgery(P<0.05).There was no statistically difference in MMES scores among the three groups of patients before operation(P>0.05).Compared with Group D,MMES scores of Groups C and L were decreased on the first day,third day,and seventh day after surgery(P<0.05).There was no statistically significant difference between group C and group L in MMES scores on the first day,third day,and seventh day after surgery(P>0.05).Conclusions The dexmedetomidine combined with controlled low central venous pressure could effectively reduce the bleeding in patients underwent laparoscopic hepatectomy,and it has no influence on renal function,indeed,it reduces the incidence of postoperative cognitive function.
作者
陶静
史浩
梁启胜
TAO Jing(Department of anesthesia,the first affiliated hospital of Bengbu Medical College,Bengbu,Anhui,233000,China.)
出处
《齐齐哈尔医学院学报》
2019年第20期2548-2551,共4页
Journal of Qiqihar Medical University
基金
蚌埠医学院第一附属医院高新技术项目(2019082)
关键词
右美托咪定
低中心静脉压
术后认知功能障碍
肝切除
Dexmedetomidine
Low central venous pressure
Postoperative cognitive dysfunction
Hepatectomy
