酒石酸布托啡诺联合右美托咪定超前镇痛对老年膀胱癌根治术病人苏醒期躁动及术后短期内认知功能的影响

doi:10.3969/j.issn.1003-9198.2023.03.007

摘要/Abstract

摘要： 目的探讨酒石酸布托啡诺联合右美托咪定超前镇痛对行膀胱癌根治术老年病人苏醒期躁动及术后认知功能障碍(POCD)的影响。方法选取90例行膀胱癌根治术的老年病人,随机分为对照组和观察组,每组45例。对照组采用右美托咪定,观察组采用酒石酸布托啡诺联合右美托咪定超前镇痛。比较2组病人血流动力学指标、苏醒期躁动评分、POCD发生率以及不同时间点MMSE评分、VAS评分、血清炎性因子表达水平。结果对照组拔管时平均动脉压、心率均高于入室时及观察组(P＜0.05)。观察组苏醒期躁动发生率为8.89%,对照组为28.89%,差异有统计学意义(P＜0.05)。观察组病人术后1、3 d MMSE评分明显高于对照组(P＜0.05)。术后观察组共发生POCD 4例(8.89%),对照组共发生POCD 15例(33.33%),差异有统计学意义(P＜0.05)。观察组术后4 h、12 h、1 d VAS评分显著低于对照组(P＜0.05)。与对照组相比,观察组术后12 h、1 d、3 d,血清IL-1β、IL-6、TNF-α水平均明显降低(P＜0.05)。结论酒石酸布托啡诺联合右美托咪定超前镇痛能使行膀胱癌根治术的老年病人拔管期血流动力学更平稳,有效减轻病人术后疼痛,减少炎性因子的表达以及苏醒期躁动、POCD的发生。

关键词: 酒石酸布托啡诺, 右美托咪定, 老年人, 膀胱癌, 苏醒期躁动, 术后认知功能障碍

Abstract: Objective To investigate the effect of butorphanol tartrate combined with dexmedetomidine preemptive analgesia on emergence agitation and postoperative cognitive dysfunction (POCD) in the elderly patients with bladder cancer undergoing radical operation. Methods A total of 90 elderly patients who underwent radical resection of bladder cancer in Xuzhou Central Hospital from August 2019 to December 2021 were enrolled in this study. The patients were randomly divided into control group and observation group, with 45 cases in each group. The control group received dexmedetomidine preemptive analgesia, and the observation group received butorphanol tartrate combined with dexmedetomidine preemptive analgesia. The levels of hemodynamic indexes, agitation score, the scores of Mini Mental State Examination(MMSE), visual analogue scale (VAS) and the levels of inflammatory factors at different time points and the incidence rate of POCD were compared between the two groups. Results The levels of mean arterial pressure and heart rate in the control group at extubation immediately were significantly higher than those in the observation group and those before anesthesia (P<0.05). The incidence rate of emergence agitation in the observation group was 8.89%, compared with 28.89% in the control group(P<0.05). MMSE scores in the observation group were significantly higher than those in the control group 1 and 3 days after operation(P<0.05). There were 4 cases of POCD(8.89%) in the observation group and 15 cases of POCD(33.33%) in the control group after operation, with significant difference(P<0.05). The VAS score in the observation group was significantly lower than that in the control group 4 h, 12 h and 1 d after operation(P<0.05). Compared with the control group, the levels of IL-1β, IL-6, TNF-α in the observation group 12 h, 1 d and 3 d after operation were significantly decreased(P<0.05). Conclusions For the elderly patients with bladder cancer undergoing radical operation, butorphanol tartrate combined with dexmedetomidine preemptive analgesia can keep the extubation hemodynamics more stable, and can effectively reduce the postoperative pain, the expression of inflammatory factors and the incidence of emergence agitation and POCD.

Key words: butorphanol tartrate, dexmedetomidine, aged, bladder cancer, emergence agitation, postoperative cognitive dysfunction

中图分类号:

R 614

郑伟, 李娜, 庞昆, 胡正权, 刘杰. 酒石酸布托啡诺联合右美托咪定超前镇痛对老年膀胱癌根治术病人苏醒期躁动及术后短期内认知功能的影响[J]. 实用老年医学, 2023, 37(3): 238-242.

ZHENG Wei, LI Na, PANG Kun, HU Zheng-quan, LIU Jie. Effect of preemptive analgesia with butorphanol tartrate combined with dexmedetomidine on emergence agitation and postoperative cognitive dysfunction in elderly patients with bladder cancer undergoing radical operation[J]. Practical Geriatrics, 2023, 37(3): 238-242.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] GALSKY M D. How I treat bladder cancer in elderly patients[J]. J Geriatr Oncol,2015,6(1):1-7.
[3] WITJES J A, BRUINS H M, CATHOMAS R, et al. European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer:summary of the 2020 guidelines[J]. Eur Urol, 2021, 79(1):82-104.
[4] TAN X X, QIU L L, SUN J. Research progress on the role of inflammatory mechanisms in the development of postoperative cognitive dysfunction[J]. Biomed Res Int, 2021:3883204.
[5] 边志民.老年肿瘤患者合并术后认知功能障碍的影响因素及诊断防治策略[J]. 中国现代医学杂志, 2021,31(13):1-4.
[6] 于跃,孟波,陈骏萍. 术后认知功能障碍临床研究方法简史[J].现代实用医学,2021,31(7): 846-848.
[7] 于威威, 赵平. 右美托咪定用于预防小儿全麻苏醒期躁动的应用进展[J]. 实用药物与临床, 2013, 16(5): 432-434.
[8] 尚延昌, 解恒革, 谢越. AD8 联合简易智能状态检查量表用于军队健康体检人群认知功能障碍筛查的初步研究[J]. 中华老年心脑血管病杂志, 2018, 20(4): 340-343.
[9] 张延平,曹宏,刁玉晶,等.右美托咪定复合罗哌卡因在行全膝关节置换术后镇痛中的效果[J].医学临床研究,2019,36(2): 382-383.
[10] MARTINEZ RODRIGUEZ R H, BUISAN RUEDA O, IBARZ L. Bladder cancer: present and future[J]. Med Clin: Barc, 2017, 149(10): 449-455.
[11] LIN W Y, WU C T, CHEN M F, et al. Cystectomy for bladder cancer in elderly patients is not associated with increased 30- and 90-day mortality or readmission, length of stay, and cost: propensity score matching using a population database[J]. Cancer Manag Res,2018,10: 1413-1418.
[12] AGLIO L S, ABD-EL-BARR M M, ORHURHU V, et al. Preemptive analgesia for postoperative pain relief in thoracolumbosacral spine opera-tions: a double-blind,placebo-controlled randomized trial[J]. J Neurosurg Spine,2018,29(6): 647-653.
[13] 黄宇光,黄文起,李刚,等.酒石酸布托啡诺镇痛专家共识[J].临床麻醉学杂志,2011,27(10):1028-10209.
[14] 张红,严祥,冷玉芳.右美托咪定镇痛作用的临床研究进展[J].国际麻醉学与复苏杂志,2017,38(6): 550-553.
[15] 孙光梅,刘姚珍,王欢. 右美托咪定联合布托啡诺超前镇痛对老年结直肠癌手术围术期疼痛介质的影响[J]. 中国老年学杂志,2020,40(19):4136-4138.
[16] 郭亮,潘灵辉.老年患者术后认知功能障碍的研究进展[J].中华老年多器官疾病杂志,2017,16(4): 317-320.
[17] 郑熠.右美托咪定对老年患者全身麻醉术后认知功能障碍的影响[J]. 中国医药,2018,13(6):934-937.
[18] 帅兵,柯毓文.从海马区自噬水平探讨右美托咪定缓解老年患者全身麻醉术后认知功能障碍的作用机制[J]. 中国临床药学杂志,2020,29(2):99-102.
[19] 张少琼,刘畅. 神经炎症在术后认知功能障碍中的作用及右美托咪定对其的治疗机制[J]. 临床医药文献电子杂志,2019,6(48):195-197.
[20] 唐雯,曾志英,,周杰. 右美托咪定滴鼻联合布托啡诺超前镇痛在腹腔镜胆囊切除术中的应用[J]. 湖南师范大学学报(医学版),2021,18(4):21-24.
[21] 李晓青,曹雪鹏,朱伟超,等. 布托啡诺超前镇痛对肺癌患者胸腔镜肺叶切除术围术期应激反应及术后疼痛的影响[J]. 肿瘤研究与临床,2021,33(1):28-32.