Zhang Li-Yun, Zhang Yu-Hao, Shen Jie, Luo Yan
Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Ann Palliat Med. 2019 Sep;8(4):469-475. doi: 10.21037/apm.2019.08.09.
This study aimed to investigate the effects of dexmedetomidine on the post-operative recovery and mental status in patients receiving robotic-assisted thoracic surgery (RATS).
One hundred patients who received selective RATS under general anesthesia were recruited and assigned into control group (C) and dexmedetomidine group (D). The anesthesia induction and maintenance were consistent between groups. Midazolam, sufentanil, propofol and rocuronium were intravenously injected for anesthesia induction, followed by mechanical ventilation after endotracheal intubation. Sevoflurane inhalation at a minimum alveolar concentration (MAC) of 0.5 was administered, propofol and remifentanil were intravenously injected to maintain the bispectral index (BIS) at 40-60, and rocuronium was intravenously injected once every 30 min. In the D group, dexmedetomidine was intravenously injected after endotracheal intubation, and then it was injected before the end of surgery. In the C group, normal saline of equal volume was injected. The hemodynamic parameters, blood loss, urine volume, time of surgery, time of anesthesia, total dose of propofol, time of thoracic tube indwelling, hospital stay and pulmonary complications were recorded; blood gas analysis was performed after extubation; the QoR-15 and mini-mental state examination (MMSE) questionnaires were employed for the assessment of mental status at 1 and 3 days after surgery.
The mean arterial pressure (MAP), heart rate (HR) and brain oxygenation were similar between groups at different time points (P>0.05). There were no significant differences in the operation time, time of anesthesia and intra-operative urine volume between groups. As compared to the C group, the blood loss and dose of propofol reduced significantly (P<0.05). After extubation, the respiratory frequency reduced and PaO2 increased markedly (P<0.05). After surgery, the time of thoracic tube indwelling and hospital stay reduced dramatically in the D group as compared to the C group (P<0.05). The QoR-15 score and MMSE score in the D group were markedly higher than in the C group (P<0.05).
Dexmedetomidine can improve the post-operative recovery and mental status after RATS.
本研究旨在探讨右美托咪定对接受机器人辅助胸外科手术（RATS）患者术后恢复及精神状态的影响。
招募100例在全身麻醉下接受选择性RATS手术的患者，分为对照组（C组）和右美托咪定组（D组）。两组间麻醉诱导和维持方法一致。静脉注射咪达唑仑、舒芬太尼、丙泊酚和罗库溴铵进行麻醉诱导，气管插管后行机械通气。吸入七氟烷，最低肺泡浓度（MAC）为0.5，静脉注射丙泊酚和瑞芬太尼以维持脑电双频指数（BIS）在40 - 60，每30分钟静脉注射一次罗库溴铵。在D组，气管插管后静脉注射右美托咪定，然后在手术结束前再次注射。在C组，注射等体积的生理盐水。记录血流动力学参数、失血量、尿量、手术时间、麻醉时间、丙泊酚总剂量、胸管留置时间、住院时间及肺部并发症；拔管后进行血气分析；采用QoR - 15和简易精神状态检查表（MMSE）问卷评估术后1天和3天的精神状态。
不同时间点两组间平均动脉压（MAP）、心率（HR）及脑氧合情况相似（P>0.05）。两组间手术时间、麻醉时间及术中尿量无显著差异。与C组相比，D组失血量和丙泊酚剂量显著减少（P<0.05）。拔管后，呼吸频率降低，动脉血氧分压（PaO2）显著升高（P<0.05）。术后，与C组相比，D组胸管留置时间和住院时间显著缩短（P<0.05）。D组的QoR - 15评分和MMSE评分显著高于C组（P<0.05）。
右美托咪定可改善RATS术后恢复及精神状态。
