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| 右美托咪定对精准肝切除术患者在麻醉科ICU期间肝功能的影响 |
| Effect of dexmedetomidine for patients undergoing precisehepatectomy in anesthesia intensive care unit |
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| DOI：10.12089/jca.2018.12.016 |
| 中文关键词: 右美托咪定 精准肝切除术 肝功能 术后谵妄 麻醉科ICU |
| 英文关键词: Dexmedetomidine Precise hepatectomy Liver function Postoperative delirium Anesthesia intensive care unit |
| 基金项目:国家自然科学青年基金(81500955H0903) |
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| 中文摘要: |
目的 观察精准肝切除术患者在麻醉科ICU(anesthesia intensive care unit, AICU)应用右美托咪定对术后早期肝功能和谵妄的影响。
方法 选择精准肝叶切除术患者40例, 男30例, 女10例, 年龄34～65岁, ASA Ⅱ或Ⅲ级, 随机分为右美托咪定组(D组)和生理盐水组(S组)，每组20例。入AICU后拔管前D组给予右美托咪定0.5 μg·kg-1·h-1和丙泊酚0.5 mg·kg-1·h-1持续静脉泵入, S组给予生理盐水和丙泊酚0.5 mg·kg-1·h-1;拔管后D组维持原剂量右美托咪定泵注, S组给予同等剂量生理盐水。两组患者均接受按压式镇痛泵术后镇痛。记录镇静有效率和按压次数；记录术前(T0)、入AICU后即刻(T1)和术后12 h(T2)血浆谷草转氨酶(AST)、谷丙转氨酶(ALT)和血乳酸(Lac)浓度；记录心动过缓、低血压、低血氧饱和度和术后谵妄等不良反应的发生情况。
结果 D组镇静有效率明显高于S组［(80.2±13.0)％ vs (61.8±14.7)％, P<0.05］, 镇痛泵按压次数明显少于S组［(2.3±0.7)次vs (4.1±1.2)次, P<0.05］；与T0时比较,T1和T2时两组AST、ALT和Lac浓度明显升高(P<0.05);与T1时比较, T2时两组AST、ALT和Lac浓度明显升高(P<0.05);T2时S组AST、ALT和Lac浓度明显高于D组(P<0.05)。两组心动过缓、低血压和术后谵妄[1（5%） vs 3(15%)]发生率差异无统计学意义。
结论 精准肝切除术患者在AICU期间使用右美托咪定可减少患者焦虑情绪, 对肝脏功能有一定的保护作用。 |
| 英文摘要: |
Objective To study the effect of dexmedetomidine on the recovery quality and organ protection of patients undergoing precise hepatectomy in anesthesia intensive care unit (AICU).
Methods Forty patients undergoing precise hepatectomy, 30 males and 10 females, aged 34 - 65 years, ASA physical status Ⅱ or Ⅲ, were randomly divided into saline group (group S, n = 20) and dexmedetomidine group (group D, n = 20). Dexmedetomidine 0.5 μg·kg-1·h-1 and propofol 0.5 mg·kg-1·h-1 were intravenously administered in group D when patients were treated in AICU. Saline and propofol 0.5 mg·kg-1·h-1were administrated in patients of group S. Patients in group D maintained original dose of dexmedetomidine by microinfusion pump after extubation, whereas patients in group S received saline after extubation. Patients in each group received postoperative analgesia with analgesia pump. Sedation efficiency and pressing times of analgesic pump were recorded. Levels of AST, ALT and blood Lac before surgery (T0), admission in AICU (T1) and 12 h after surgery (T2) were recorded, respectively. Moreover, side effects of low heart rate, low blood pressure, and postoperative delirium of patient were recorded.
Results The sedation effecttiveness of group D was higher than that of group S ［(80.2 ± 13.0)％ vs (61.8 ± 14.7)％, P < 0.05］, and the frequency of analgesia pump was less than that of group S ［(2.3 ± 0.7) times vs (4.1 ± 1.2) times, P < 0.05］. The levels of AST, ALT and Lac of both groups at T1 and T2 were higher than T0(P < 0.05). AST, ALT and Lac of both groups at T2 were higher than those at T1(P < 0.05). Particularly, these indicators were remarkably increased in group S than those of group D at T2 (P < 0.05). There were no significant differences in side effects between the two groups, and no hypoxemia occurred in the two groups. No significant difference was found in the incidence of postoperative delirium between the two groups.
Conclusion The use of dexmedetomidine during AICU in patients undergoing precise hepatectomy can reduce anxiety, and protect the liver function. |
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