目的 观察腹腔镜胃肠癌手术患者在麻醉手术中应用右美托咪定( Dex)与血必净对术后谵妄发生的影响.方法 选择80例择期在腹腔镜下实施的胃肠癌手术患者进行观察.随机分成4组:常规麻醉组(C组)、Dex组(D组)、血必净组(X组)及Dex联合血必净组(DX组).干预措施:D组患者麻醉诱导时给予Dex 1.0 μg/kg负荷量静脉泵注;X组患者术中给予血必净50 mL 静脉滴注;DX组患者麻醉诱导时给予Dex 1.0 μg/kg负荷量静脉泵注(泵注时间20 min)和术中给予血必净50 mL静脉滴注;C组患者予等量的生理盐水.记录麻醉手术中患者生命体征、NI、用药、输液、出血量、麻醉时间、拔管时间等.于术毕当天行CAM-ICU对患者谵妄进行评估;术后第1、2天行CAM-CR量表评估.结果 4 组患者麻醉药物用量及麻醉时间、术中补液量、出血量比较差异无统计学意义(P＞0.05). 4组硝酸甘油、阿托品例数情况差异无统计学意义(P＞0.05).但阿拉明在4组间的用量差异有统计学意义(P＜0.05),其中X组与DX组的用药量较大.术后第1、2天采用CAM-CR量表评分显示4组患者术后第1、2天均未发生谵妄;且组内比较差异无统计学意义(P＞0.05). 4组患者术毕当天CAM-ICU评分显示组间比较差异有统计学意义(P＜0.05).术毕当天共有9例患者发生谵妄:与C 组比较,D 组患者术后谵妄发生率显著降低,差异有统计学意义( P ＜0.05).结论 腹腔镜胃肠癌手术患者麻醉中单独应用Dex,可减低术后早期谵妄发生率.麻醉中单独应用血必净未见对术后早期谵妄发生率有明显减低作用.%Objective To observe the influence of using dexmedetomidine ( Dex) combined with Xuebijing on the incidence of postoperative delirium in laparoscopic resection of gastrointestinal cancers .Methods Eighty cases of se-lective laparoscopic surgery were enrolled .The patients were randomly divided into 4 groups, routine anesthesia group (Group C), Dex group (Group D), Xuebijing group (Group X), Dex combined with Xuebijing group (Group DX).Dex (1.0 μg/kg), Xuebijing (50 mL), both Dex and Xuebijing, and placebo saline were given during operation for patients in Group D, Group X, Group DX and Group C, respectively.Preoperative, intraoperative (after skin incision 1 h) and postoperative gas analysis were performed .Vital signs, narcotrend, drug use, fluid input volume, bleeding volume, anes-thesia time, extubation time and leaving time were recorded during operation .Moreover, CAM-ICU evaluation was im-plemented on the same day of the operation , and CAM-CR evaluation was implemented on the Day 1 and the Day 2 after operation.Results There was no significant difference among the 4 groups in anesthetic dosage , anesthesia time, volume of fluid input or blood loss (P＞0.05).There was no significant difference in nitroglycerin or atropine needs among the 4 groups (P＞0.05).Yet significantly higher dosage of aramine was required in Group X and DX (P＜0.05).There was no postoperative delirium according to the results of CAM -CR evaluations on the Day 1 and 2 after operation.According to CAM-ICU evaluation results (same day after operation), there were significant differences among the 4 groups in de-lirium (P＜0.05), and there were 9 patients had delirium after operation at the same day .Compared with Group C, there was significant reduction on the incidence of postoperative delirium for in Group D (P＜0.05).Conclusion The usage of Dex in laparoscopic gastric cancer surgery could reduce the incidence of postoperative delirium .The usage of Xuebijing could hardly reduce the incidence of postoperative delirium for such patients.
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