右旋美托咪啶对老年腹腔镜手术患者围手术期应激状态及麻醉质量的影响

Effect of dexmedetomidine on perioperative stress situation and anesthesia quality for elderly patients undergoing laparoscopic surgery

目的:评价持续输注右旋美托咪啶对老年腹腔镜手术患者围手术期应激状态及麻醉质量的影响。方法:选择拟行腹腔镜手术的老年患者120例,采用随机数字表法,随机分为对照组(C组,n=60)与右旋美托咪啶组(D组,n=60)。D组麻醉诱导前10 min静脉持续输注右旋美托咪啶0.3μg.kg-1.h-1至手术结束,C组以相同速率静脉输注等容量生理盐水。术中维持BIS值40～50,呼气末二氧化碳分压(PETCO2)维持在35～45 mmHg,CO2气腹压力维持在10～13 mmHg。手术结束前20 min停止所有麻醉药物,术毕连接PCIA送入苏醒室。记录患者麻醉诱导前(T0)、气管插管时(T1)、气腹后10 min(T2)、术毕(T3)、拔管即刻(T4)的MAP、HR、SPO2,同时测定血浆去甲肾上腺素(NE)、血糖(GLU)、血浆皮质醇(Cor)浓度;记录患者麻醉时间、气腹时间、拔管时间、患者术后不良反应及拔管后10 min术后疼痛Prince-Henry评分等。结果:两组患者气腹时间、麻醉时间、拔管时间及Prince-Henry评分等指标差异无统计学意义(P>0.05)。与T0相比,两组患者T1～T4时MAP、HR及血NE、GLU、Cor均升高(P<0.05),尤以T2时HR、GLU、Cor升高为著(P<0.01);与C组相比,D组T1～T4时HR及血GLU、Cor均显著降低(P<0.05);术后不良反应等亦显著降低(P<0.05)。结论:持续输注右旋美托咪啶可合理控制老年腹腔镜手术患者围手术期应激反应,减少术后并发症,提高麻醉质量。

Objective：To investigate the effect of continuous infusion of dexmedetomidine on stress situation and anesthesia quality for elderly patients undergoing laparoscopic surgery. Methods： One hundred and twenty ASA Ⅰ-Ⅱ patients of both sexes aged 65-75 y with body mass index 22-28 kg/m^2, scheduled for laparoscopy,were randomly divided into 2 groups：control group （group C, n = 60） and dexmedetomidine group （ group D, n = 60）. Dexmedetomidine 0.3 μg·kg^-1·min^-1 was infused intravenously from 10 rain before induction of anesthesia to the end of the surgery in group D ,while equal volume of normal saline was infused in group C at the same speed with group D. The two groups received the same method of anesthetic induction and anesthetic maintaining. The elderly patients underwent trachea cannula and were mechanically ventilated. BIS was maintained at 40-50, end-expiratory pressure of carbon dioxide was 35-45 mmHg during operation and pneumoperitoneum CO2 gas pressure was 10-13 mmHg. All anesthesia drugs were stopped 20 rain before the end of operation, and the patients were transferred to the care unit with PCIA at the end of the operation. The MAP, HR, SPO2 and NE, GLU, Cot were recorded or determined at pre-induetion （To ） , tracheal intubation （T1 ） , 10 min after pneumoperitoneum （ T2 ）, the end of the operation （ T3 ） and extubation （ T4 ）. The dosage of fentanyl and propofol were computed from intraoperative to postoperative T4. Anesthetic time, pneumoperitoneum CO2 gas time, extubation time, postoperative adverse reaction and Prince-Henry scores for postoperative pain were recorded. Results ： There were no statistically significant differences in anesthetic time, pnenmoperitoneum CO2 gas time, extubation time and Prince-Henry scores （ P 〉 0.05 ）. Compared with To , MAP, HR, NE, GLU and Cor were higher at T1-4 （ P 〈 0.05 ）. Especially at T2, MAP, HR and Cot increased significantly （ P 〈 0.01 ） ; Compared with group C, in group D, HR, GLU and Cot were significantly lower at T,.4, the postoperative complications were significantly less （ P 〈 0.05 ）. Conclusions ： Continuous infusion of dexmedetomidine can not only reasonably control the perioperative stress reaction of elderly patients with laparoseopic surgery, but can also reduce the postoperative complications, and improve the quality of anesthesia.