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右美托咪啶对达芬奇机器人辅助胸外科手术患者术后恢复质量和智能精神状态的影响
Effect of dexmedetomidine on quality of recovery and postoperative mental state in patients undergoing robotic-assisted thoracic surgery
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DOI:
作者:
张丽芸,张昱昊,沈杰,罗艳
ZHANG Liyun, ZHANG Yuhao, SHEN Jie, LUO Yan
作者单位:
上海交通大学医学院附属瑞金医院
Department of Anesthesiology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine
关键词:
右美托咪啶;机器人手术;胸外科手术;恢复质量;术后智能精神状态
Dexmedetomidine; Robotic surgery; Thoracic surgery; Quality of recovery; Postoperative mental state
摘要:
目的 评价右美托咪啶对达芬奇机器人辅助胸外科手术患者术后恢复质量和智能精神状态的影响。方法 择期全麻下行达芬奇机器人辅助胸外科手术患者60例,性别不限,年龄20~70岁,身体质量指数<30kg•m-2,ASA分级I级或II级,采用随机数字表法,将患者随机分为2组(n=30):生理盐水对照组(C组)和右美托咪啶组(D组)。2组患者麻醉诱导和维持方法相同。静脉注射咪达唑仑、舒芬太尼、异丙酚和罗库溴铵进行麻醉诱导,气管插管后行机械通气。麻醉维持:吸入七氟烷,使MAC值维持在0.5,泵注异丙酚和瑞芬太尼,维持BIS值40~60,每隔30min静脉注射罗库溴铵。D组气管插管后10min内按1mg•kg-1剂量静脉输注右美托咪啶,随后泵注右美托咪啶0.4mg•kg-1•h-1至手术结束前30min,C组给予等容量生理盐水。记录不同时点血流动力学数据,记录术中失血量、尿量、手术时间、麻醉时间、异丙酚总量,并于拔管后吸空气状态下行动脉血气分析,记录术后拔除胸引管天数、住院天数和肺部并发症的情况,并分别于术前、术后第一天和术后第三天完成QoR-15量表和MMSE量表。结果 两组患者术中不同时点MAP、HR、脑氧的差异无统计学意义(P>0.05)。两组患者手术时间、麻醉时间、术中失血量和尿量的差异无统计学意义(P>0.05)。与C组比较,D组的异丙酚用量降低(P<0.05)。拔管后,吸空气状态下,D组呼吸频率降低、PaO2增高(P<0.05)。术后,D组拔除胸引管的时间减少,术后住院天数减少(P<0.05),QoR-15量表和MMSE量表得分均高于C组(P<0.05)。结论 右美托咪啶可改善达芬奇机器人辅助胸外科手术患者术后恢复质量和智能精神状态。
Objective To evaluate the effect of dexmedetomidine on quality of recovery and postoperative mental state in patients undergoing robotic-assisted thoracic surgery. Methods Sixty ASA I or II patients of both sexes, aged 20`70 with body mass index < 30 kg•m-2, scheduled for robotic-assisted thoracic surgery under general anesthesia, were randomly divided into 2 groups(n=30 each): normal saline control group(group C) and dexmedetomidine group(group D). Anesthesia was induced with midazolam, sulfentanyl, propofol and rocuronium. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with sevoflurane inhalation by keeping MAC at 0.5, continuous pump infusion of propofol and remifentanil, and injection of rocuronium every 30 min. BIS was maintained at 40~60. In group D, dexmedetomidine 1mg•kg-1 was infused intravenous over 10 min followed by continuous intravenous infusion at 0.4mg•kg-1•h-1 until 30 min before the end of operation. Group C received the equal volume of normal saline. At different time, hemodynamic parameters were recorder. Blood loss, urine volume, operation time, anesthesia time, consumption of propofol, arterial blood gas analysis at room air after extubation, time to chest tube removal, length of hospital stay and postoperative complication were observed and recorded. QoR-15 and MMSE were scored on preoperative day, postoperative day 1 and 3. Results There was no significant difference in MAP, HR and cerebral oxygen at different time(P>0.05). There was no significant difference in operation time, anesthesia time, blood loss and urine volume(P>0.05). Consumption of propofol in group D was statistically lower than that in group C(P<0.05). Compared with group C, after extubation, respiratory rate was statistically lower and PaO2 was higher in group D(P<0.05). Time to chest tube removal and length of hospital day were significantly shorter in group D compared with group C(P<0.05). The QoR-15 score on postoperative day 1 and MMSE score on postoperative day 1 and 3 were significantly higher in group D compared with group C(P<0.05). Conclusion Intraoperative dexmedetomidine administration could improve quality of recovery and postoperative mental state in patients undergoing robotic-assisted thoracic surgery.
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