Clinical study on the preventive effects and safety of dexmedetomidine on postoperative hypoxemia in elderly patients with gy-necological tumors
Objective To observe the preventive effects of dexmedetomidine on hypoxemia in elderly patients with gy-necological tumors after lower abdominal open surgery.Methods 78 elderly gynecological tumor patients who underwent low-er abdominal open surgery in Affiliated Cancer Hospital of Fudan University from August 2023 to February 2024 were enrolled and randomly divided into Dex group(n=39)and control group(n=39)by random number table method.Patients in the Dex group were given 0.5 μg/kg load dose of dexmedetomidine after entering the operating room,and 0.2 μg/(kg·h)main-tenance dose of dexmedetomidine after intubation.Patients in the control group received equal amount of normal saline.The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO2)before sedation(T1),15 mins after extubation(T2),30 mins after extubation(T3),and 1 h after extubation(T4)of both groups were measured and compared.The arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO2)at T1 and T3 of both groups were measured and compared.The incidence of hypoxemia(SpO2＜90％)within 1 hour of extubation,as well as the postoperative pain numerical rating scale(NRS)score and postoperative sedation Ramsay score were recorded and compared between the two groups.The incidences of intraoperative bradycardia,intraoperative hypo-tension,and postoperative nausea and vomiting were recorded and compared between the two groups.Results Compared with the control group,HR at T3,SBP at T2 and T4,and DBP at T2 in the Dex group were all lower,and the differences were sta-tistically significant(P＜0.05).There were no significant differences in SpO2,PaO2 and PaCO2 values between the two groups at each time point(P＞0.05).The incidence of hypoxemia in the Dex group was significantly lower than that in the control group(5.1％vs 46.2％,P＜0.001).Multiple logistic regression analysis showed that treatment(Dex group vs con-trol group)was an independent protective factor for hypoxemia(P=0.008,OR=0.024),and advanced age was an independ-ent risk factor for hypoxemia(P=0.045,OR=1.181).The postoperative pain NRS score of the Dex group was lower than that of the control group(P＜0.001).There was no significant difference in postoperative sedation Ramsay score between the two groups(P＞0.05).There were no significant differences in the incidence of intraoperative bradycardia,hypotension and postoperative nausea and vomiting between the two groups(P＞0.05).Conclusion Dexmedetomidine can prevent the occur-rence of hypoxemia after lower abdominal open surgery in elderly patients with gynecological tumors,and it is well tolerated.
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