右美托咪定对行肝叶切除术的老年患者睡眠质量、炎症因子和谵妄发生率的影响

Effects of dexmedetomidine on sleep quality,inflammatory factors and incidence of postoperative delirium in elderly patients undergoing hepatic lobectomy

中文关键词: 老年  肝叶切除术  右美托咪定  睡眠质量  炎症因子  谵妄

英文关键词: elderly  hepatic lobectomy  dexmedetomidine  sleep quality  inflammatory factor  delirium

中文摘要:

      目的 探讨右美托咪定对行腹腔镜肝叶切除术的老年患者术后睡眠质量、炎症因子和谵妄(POD)发生率的影响.方法 选择2022年1月-2024年5月于右江民族医学院附属医院接受腹腔镜肝叶切除术患者120例,按随机数字表法分为观察组和对照组,每组60例.观察组麻醉成功后泵入右美托咪定,对照组泵入与观察组等体积的生理盐水.比较2组患者睡眠质量[匹兹堡睡眠质量(PSQI)评分]、炎症因子[肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]水平、术后疼痛感[视觉疼痛模拟(VAS)评分]、术后POD发生率及麻醉药物使用情况.结果 术后48h,观察组PSQI量表评分低于对照组(P＜0.05);术后24h,观察组TNF-α、CRP水平均低于对照组(P＜0.05);观察组术后12、24、48 h的VAS评分均低于对照组(P＜0.05);观察组术后POD发生率低于对照组(P＜0.05);观察组术中丙泊酚、瑞芬太尼、顺苯磺酸阿曲库铵用量及术后芬太尼、镇痛泵用量、24 h镇痛泵按压次数均低于对照组(P＜0.05).结论 右美托咪定泵注可改善腹腔镜肝叶切除术老年患者术后睡眠质量,缓解术后炎症反应,降低术后疼痛感和POD发生率.

英文摘要:

      Objective To investigate the effects of dexmedetomidine on sleep quality,inflammatory factors and inci-dence of postoperative delirium(POD)in elderly patients undergoing laparoscopic hepatic lobectomy.Methods A total of 120 patients who underwent laparoscopic hepatic lobectomy in Affiliated Hospital of Youjiang Medical University for Nationali-ties from January 2022 to May 2024 were selected and divided into observation group and control group according to a random number table,with 60 cases in each group.The observation group received infusion of dexmedetomidine after successful anes-thesia,while the control group received infusion of equal volume of normal saline.The postoperative sleep quality[Pittsburgh Sleep Quality Index(PSQI)],inflammatory factors[tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)],post-operative pain[Visual Analogue Scale(VAS)score],the incidence of POD,and intraoperative anesthetic consumption were compared between the two groups.Results At 48 h after surgery,the PSQI score in the observation group was lower than that in the control group(P＜0.05).At 24 h after surgery,the levels of TNF-α and CRP in the observation group were lower than those in the control group(P＜0.05).At 12,24,and 48 h after surgery,the VAS scores in the observation group were lower than those in the control group(P＜0.05).The incidence of POD in the observation group was lower than that in the control group(P＜0.05).The intraoperative dosages of propofol,remifentanil and cisatracurium besylate,as well as postoperative dosage of fentanyl,consumption of analgesics and 24 h pressing times of analgesic pump in the observation group were lower than those in the control group(P＜0.05).Conclusion Infusion of dexmedetomidine can improve postoperative sleep quality of elderly patients undergoing laparoscopic hepatic lobectomy,alleviate postoperative inflammatory reaction and reduce postop-erative pain as well as the incidence of POD.