右美托咪定配合腰方肌区域神经阻滞对老年结肠癌患者术后谵妄的影响

摘要/Abstract

摘要： 目的探讨右美托咪定配合腰方肌区域神经阻滞对老年结肠癌患者术后谵妄的影响。方法选取徐州医科大学附属医院2021年1月—2022年6月收治的80例老年结肠癌患者,按照随机数表法分为观察组和对照组。观察组的40例患者麻醉诱导前应用右美托咪定,对照组的40例患者未应用。所有患者均行结肠癌根治术,对照组患者采取全身麻醉联合腰方肌区域神经阻滞,观察组患者在全身麻醉联合腰方肌区域神经阻滞诱导前增加右美托咪定。对比两组患者不同时间[入室时的基础值（T₁）,开始镇静时（T₂）,入镜时（T₃）,检查结束时（T₄）4个不同时间]舒张压（SBP）、收缩压（DBP）、平均动脉压（MAP）、心率（HR）表达水平,静息与运动下视觉模拟量表（VAS）评分,不良情况与术后谵妄发生率。结果两组患者T₁SBP、DBP、MAP、HR对比差异无统计学意义（P>0.05）,观察组患者同组间T₁、T₂、T₃、T₄SBP、DBP、MAP、HR对比差异无统计学意义（P>0.05）,对照组T₁—T₂SBP、DBP、HR水平降低,T₃升高,T₄恢复平稳,且观察组T₂ SBP、DBP、MAP水平高于对照组,T₃ SBP、DBP、HR水平低于对照组（P<0.05）;两组患者术后2~12 h 静息状态VAS评分升高,且观察组低于对照组（P<0.05）,两组患者术后12~48 h 运动状态VAS评分逐渐降低,且观察组低于对照组（P<0.05）,观察组术后疼痛持续时间明显低于对照组（P<0.05）。两组患者心动过缓、低氧血症、低血压等不良情况发生率对比差异无统计学意义（P>0.05）;观察组患者术后谵妄发生率明显低于对照组（P<0.05）。结论对老年结肠癌患者使用右美托咪定后再行全身麻醉联合腰方肌区域神经阻滞能够稳定患者血压与心率,降低术后静息状态与运动状态疼痛程度,降低术后谵妄发生率,且安全性较高。

关键词: 右美托咪定, 腰方肌区域神经阻滞, 结肠癌, 谵妄, 生命体征

Abstract: Objective To investigate the effect of dexmedetomidine combined with regional nerve block of lumbar quadratus muscle on postoperative delirium in elderly patients with colon cancer. Methods Eighty elderly colon cancer patients admitted to the Affiliated Hospital of Xuzhou Medical University from January 2021 to June 2022 were selected for retrospective analysis and grouped according to whether dexmedetomidine was applied in the pre-induction of anesthesia. 40 patients in the observation group had dexmedetomidine applied prior to the induction of anesthesia, while 40 patients in the control group were not applied. All patients underwent radical colon cancer, the control group patients received general anesthesia combined with trapezius regional nerve block, and the observation group increased dexmedetomidine before induction of general anesthesia combined with trapezius regional nerve block, and compared the expression levels of diastolic blood pressure (SBP), systolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) in different time [base value (T1), sedation (T2), lens(T3), end (T4)], and the scores of visual analogue scale (VAS) under rest and exercise at different times between the two groups, adverse conditions and false incidence incidence. Results There was no significant difference in SBP, DBP, MAP and HR at T₁ between the two groups (P>0.05). There was no significant difference in SBP, DBP, MAP and HR at T₁, T₂, T₃, T₄ between the two groups (P>0.05). The levels of SBP, DBP, MAP and HR decreased from T₁ to T₂, and T₄ increased from T₃, SBP, DBP and MAP were higher than the control group, and SBP, DBP, and HR were lower than the control group (P<0.05); the resting state VAS score increased between 2 h and 12 h after surgery, and the observation group was lower (P<0.05); the exercise state VAS score gradually decreased from 12 h to 48 h after surgery, and the observation group was lower (P<0.05); the postoperative pain duration was significantly lower than the control group (P<0.05). There was no significant difference in the incidence of bradycardia, hypoxemia, hypotension and other adverse events between the two groups (P>0.05). The incidence of postoperative delirium of observation group was significantly lower than that of the control group (P<0.05). Conclusion The use of dexmedetomidine followed by general anesthesia combined with lumbar quadratus block in elderly patients with colon cancer can stabilize their blood pressure and heart rate, reduce the degree of pain in resting state and exercise state, reduce the incidence of postoperative delirium, and has a high safety.

Key words: dextrmedetomidine, regional nerve block of quadratus lumbaris muscle, colon cancer, delirium, vital signs

中图分类号:

R614

裴玉平. 右美托咪定配合腰方肌区域神经阻滞对老年结肠癌患者术后谵妄的影响[J]. 中华养生保健, 2023, 41(3): 15-19.

PEI Yu-ping. Effect of Dexmedetomidine Combined with Lumbar Quadratus Regional Nerve Block on Postoperative Delirium in Elderly Patients with Colon Cancer[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(3): 15-19.

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