摘要：目的：研究不同剂量右美托咪定复合舒芬太尼对妇科腹腔镜患者术后认知功能的影响。方法：选取选取2016年1月-2018年1月在我院行择期妇科腹腔镜手术患者120例，将患者随机分为对照组、A组、B组和C组，每组各30例，A、B、C组在麻醉诱导期和维持麻醉期均加入右美托咪定，剂量分别为0.3、0.4、0.5ug/(kg·h)，对照组在相同时间给予等容积的生理盐水。观察记录患者术中不良反应发生情况，拔管时间、苏醒时间、定向力恢复时间、术后24h内疼痛程度、认知功能评分（MoCA）和术后认知功能障碍（POCD）发生情况。结果： A、B、C组苏醒时间、拔管时间、定向力恢复时间均明显低于对照组（P＜0.05），C组苏醒时间、拔管时间、定向力恢复时间均明显低于A组（P＜0.05）；A、B、C组不良反应发生率均高于对照组，C组不良反应发生率高于A、B组（P＜0.05）；A、B、C组患者在术后4h、8h、24h的VAS评分均低于同时期对照组，B、C组患者在术后4h、8h、24h的VAS评分均低于同时期A组（P＜0.05）；手术后1、3、7d， A、B、C组患者MoCA评分均高于同时间点对照组（P＜0.05）； A、B、C组POCD发生率均低于对照组（P＜0.05）。结论：对行妇科腹腔镜手术的患者，在全身麻醉时加入右美托咪定，能够有效缓解术后疼痛程度，有利于术后认知功能的恢复，从而降低POCD发生率，推荐剂量为0.4ug/(kg·h)。
Abstract: Objective: To study the effects of different doses of dexmedetomidine combined with sufentanil on postoperative cognitive function in gynecological laparoscopic patients. Methods: 120 patients who underwent gynecologic laparoscopic surgery in our hospital from January 2016 to January 2018 were randomly divided into control group, A、B、C group, each group was 30 cases. In group A, B and C, dexmedetomidine was added to the anesthesia induction period and maintenance period, the dose were 0.3, 0.4, 0.5 ug/(kg·h). The control group was given equal volume of normal saline at the same time. Observe and record the occurrence of adverse reactions, extubation time, recovery time, recovery time, postoperative 24h pain, cognitive function score and POCD occurrence. Results: The recovery time, extubation time and directional recovery time in group A, B and C were significantly lower than those in control group. recovery time, extubation time and directional recovery time in group C were significantly lower than those in group A（P＜0.05）; The incidence of adverse reactions in group A, B and C was higher than the control group, the incidence of adverse reaction in group C was higher than group A and B（P＜0.05）. The VAS scores of 4h, 8h and 24h in group A, B and C were all lower than the control group at the same time, the scores of 4h, 8h and 24h in B and C group were lower than group A（P＜0.05）; The MoCA scores of the 1、3、7d after operation, the, A, B and C groups were all higher than control group（P＜0.05）. The incidence of POCD in group A, B and C was lower than the control group（P＜0.05）. Conclusion : For patients undergoing gynecologic laparoscopic surgery, the addition of dexmedetomidine during anesthesia could relieve postoperative pain, and promote postoperative cognitive function recovery, and reduce the incidence of POCD，the recommended dose is 0.4 ug/(kg·h).
引用本文 / How to Cite This Article
何金乾.围术期不同剂量右美托咪定复合舒芬太尼对妇科腹腔镜患者术后认知功能的影响[J]. 国际精神病学杂志, 2019, 46(1): 140-142