论文部分内容阅读
目的:探讨右美托咪啶对老年肝切除术患者苏醒质量、认知功能和残余肝功能的影响，为临床应用提供指导。方法:选取2018年6月至2019年8月在承德医学院附属医院择期行肝切除术的老年患者72例，根据随机数字表法将其分为对照组和观察组，每组各36例。观察组术前10 min静脉泵注右美托咪啶0.5 μg/kg，维持浓度为0.4 μg/(kg·h)，对照组同样方式泵注等剂量0.9%浓度生理盐水。记录所有受试者麻醉诱导前(Tn 0)、麻醉诱导即刻(Tn 1)、气管插管后5 min(Tn 2)、术毕(Tn 3)、拔管后5 min(Tn 4)时点的平均动脉压(MAP)和心率(HR)，检测残余肝功能；记录患者苏醒时间、拔管时间及麻醉苏醒期间不良反应发生情况。n 结果:观察组Tn 2、Tn 3、Tn 4时的MAP、HR较Tn 0、Tn 1时略升高，但差异无统计学意义(n P>0.05)；对照组Tn 2、Tn 3、Tn 4时的MAP、HR值明显高于Tn 0、Tn 1(n P<0.05)；观察组Tn 2、Tn 3、Tn 4时的MAP、HR值明显低于同时点对照组(n P0.05)；观察组术后1 d POCD发生率明显低于对照组(n P<0.05)；随着时间的推移，两组患者血清ALT、AST水平均升高，与Tn 0比较差异有统计学意义(n P<0.05)；但观察组Tn 1、Tn 2、Tn 3、Tn 4血清ALT、AST水平均显著低于对照组同时间点(n P<0.05)；观察组麻醉苏醒期间心动过速、恶心呕吐、躁动、寒战、呛咳发生率均显著低于对照组(n P0.05); the MAP and HR at Tn 2, Tn 3 and Tn 4 in the control group were significantly higher than those at Tn 0 and Tn 1, with significant diffenence (n P<0.05); the MAP and HR at Tn 2, Tn 3 and Tn 4 in the observation group were significantly lower than those in the control group (n P0.05). The incidence of postoperative cognitive dysfunction (POCD) 1 d after operation was significantly lower than that of the control group (n P<0.05); Compared with Tn 0, the levels of serum alanine aminotransferase (ALT) and aspartate aminotrans-ferase (AST) in the two groups increased with the passage of time (n P<0.05). The levels of serum ALT and AST in observation group Tn 1, Tn 2, Tn 3 and Tn 4 were significantly lower than those in control group at the same time point (n P<0.05); the incidence of tachycardia, nausea, vomiting, restlessness, shivering and cough in observation group was significantly lower than that in control group (n P<0.05).n Conclusions:Dexmedetomidine can maintain hemodynamic stability, improve the quality of recovery, reduce postoperative cognitive damage, effectively inhibit liver injury, protect residual liver function, and have fewer complications, which is worthy of clinical application.