| 林雅文,范艳妮,俞芸芸,等.右美托咪定对经颈静脉肝内门体静脉分流术中舒芬太尼用量和术后疼痛的影响[J].中国临床保健杂志,2024,27(6):764-769. |
| 右美托咪定对经颈静脉肝内门体静脉分流术中舒芬太尼用量和术后疼痛的影响 |
| Influence of dexmedetomidine on intraoperative sufentanil dosage and postoperative pain in elderly patients with cirrhotic portal hypertension undergoing TIPS |
| 投稿时间：2024-07-02 |
| DOI：10.3969/J.issn.1672-6790.2024.06.010 |
| 中文关键词: 右美托咪定 肝硬化 高血压,门静脉 门体分流术,经颈静脉肝内 |
| 英文关键词: Dexmedetomidine Liver cirrhosis Hypertension,portal Portasystemic shunt,transjugular intrahepatic 〖FL |
| 基金项目:浙江省丽水市科技计划项目(2021SJZC014) |
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| 中文摘要: |
| 目的 探讨右美托咪定(Dex)对老年肝硬化门静脉高压症患者经颈静脉肝内门体静脉分流术(TIPS)术中舒芬太尼用量和术后疼痛的影响。方法 选取2021年10月至2023年9月丽水市中心医院收治的68例老年肝硬化门静脉高压症患者,根据随机数字表法分为Dex组与常规组,各34例,均给予静脉全身麻醉。Dex组在全身麻醉诱导前泵注Dex直至术毕前30 min。对比2组患者围麻醉期指标各时间段血流动力学指标变化,视觉模拟评分量表(VAS)得分,应激指标[皮质醇(Cor)、内皮素(ET)],简易精神状态评价量表(MMSE)评分与认知障碍、谵妄发生率,麻醉药物不良反应。结果 Dex组拔管、应答时间及丙泊酚、舒芬太尼用量均显著低于常规组(P<0.05)；心率(HR)与平均动脉压(MAP)在组间、时间点、交互作用比较,均差异有统计学意义(P<0.05),T1、T2、T3、T4时Dex组HR、MAP均显著低于常规组(P<0.05)；2组各时间段血氧饱和度(SpO2)组间差异无统计学意义(P＞0.05)；术后VAS在组间、时间点、交互作用均差异有统计学意义(P<0.05),不同时间点比较的差异有统计学意义(P<0.05),且Dex组术后3、6 h时VAS评分均显著低于常规组(P<0.05)；术后6 h,2组患者Cor、ET均显著上升(P<0.05),但Dex组术后6 h的Cor、ET水平显著低于常规组(P<0.05)；术后1 d及3 d,2组患者MMSE评分先下降后升高(P<0.05),且Dex组术后3 d的MMSE评分显著高于常规组(P<0.05),Dex组认知障碍及谵妄发生率显著低于常规组(P<0.05)；2组麻醉药物不良反应发生率比较,差异有统计学意义(P＜0.05)。结论 全身麻醉诱导前持续泵注Dex可改善老年肝硬化门静脉高压症TIPS患者麻醉质量。 |
| 英文摘要: |
| Objective To explore the influence of dexmedetomidine (Dex) on intraoperative sufentanil dosage and postoperative pain in elderly patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS).Methods Sixty-eight elderly patients with cirrhotic portal hypertension in Lishui Central Hospital from October 2021 to September 2023 were enrolled.According to the random number table method,they were divided into Dex group (34 cases) and common group (34 cases).All patients were given intravenous general anesthesia,and the Dex group was pumped with Dex before induction of general anesthesia until 30 min before the end of surgery.The changes of peri-anesthesia indicators and hemodynamic indicators,pain status (VAS),stress indicators[cortisol (Cor),endothelin (ET)],cognitive ability (MMSE),incidence rates of cognitive impairment and delirium and adverse reactions of anesthetic drugs were compared.Results The extubation time,response time and dosages of propofol and sufentanil in Dex group were significantly shorter or less than those in common group (P<0.05).There were significant differences in heart rate (HR) and mean arterial pressure (MAP) form the aspects of between-group,time-point and interaction (P<0.05).HR and MAP at T1,T2,T3 and T4 in Dex group were significantly lower than those in common group (P<0.05).There was no obvious difference in blood oxygen saturation (SpO2) between groups (P>0.05).There was a statistical difference in VAS form the aspects of between-group,time-point and interaction (P<0.05),and there was a significant difference at different time points within the groups (P<0.05).The VAS score in Dex group was significantly lower compared to common group at 3 and 6 h after surgery (P<0.05).At 6 h after surgery,the levels of Cor and ET in both groups were significantly increased (P<0.05),but the levels in Dex group were significantly lower than those in common group (P<0.05).At 1 d and 3 d after surgery,the MMSE score in the two groups was decreased first and then increased (P<0.05),and the MMSE score in Dex group at 3 d after surgery was significantly higher compared to common group (P<0.05).The incidence rates of cognitive impairment and delirium in Dex group were significantly lower than those in common group (P<0.05).The incidence of adverse reactions of anesthetic drugs revealed a significant difference between groups (P<0.05).Conclusion Continuous pump infusion of Dex before induction of general anesthesia is beneficial in improving the anesthesia quality in elderly patients with cirrhotic portal hypertension undergoing TIPS. |
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