右美托咪定复合七氟烷在腹腔镜前列腺癌根治手术中的应用

Application of dexmedetomidine combined with sevoflurane on extraperitoneal laparoscopic prostate cancer radical surgery

目的探讨右美托咪定复合七氟烷对腹膜外腹腔镜前列腺癌根治手术患者围术期血流动力学及术后恢复的影响。方法 40例ASA Ⅰ～Ⅱ级择期行腹膜外腹腔镜前列腺癌根治术患者,随机分为右美托咪定组(D组,n=20)和瑞芬太尼组(R组,n=20)。插管前给予右美托咪定或瑞芬太尼负荷量,术中以维持量静脉泵注,缝皮时停右美托咪定或瑞芬太尼。记录麻醉前(T1),气管插管后1min(T2),气腹后15min(T3)、30min(T4)、60min(T5),解除气腹后5min(T6)各时点的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、每搏量变异度(SVV)、每搏量(SV)。观察拔管时间及麻醉恢复期不良反应。结果 R组HR、MAP于T2、T3明显升高(P<0.05),CO和CI在T2、T3时点显著降低(P<0.05)。D组术后切口疼痛明显少于R组(P<0.05),D组麻醉苏醒拔管时间明显长于R组(P<0.01)。结论右美托咪定复合七氟烷麻醉用于腹膜外腹腔镜前列腺癌根治手术,术中血流动力学稳定,术后疼痛减轻,恶心呕吐减少,但麻醉恢复时间明显延长。

Objective o explore the impact of dexmedetomidine（Dex） combined sevoflurane（Sev） on the periopera-tive hemodynamics and postoperative recovery for extraperitoneal laparoscopic prostate cancer radical surgery. Methods Forty patients （ASA Ⅰ-Ⅱ ） who underwent elective surgery were randomly assigned into two groups： the prostatectomy group （group D, n=20） and the remifentanil group （group R, n=20）. Dexmedetomidine or remifentanil was given according to the loading dose before intubation to maintain the amount of intravenous infusion, Rem or Dex was stopped when skin incision was closed. Heart rate（HR）, mean arterial pressure（MAP）, cardiac output（CO）, cardiac index（CI）, stroke volume variation（SVV） and stroke volume（SV） at different time points before anesthesia（T1）, 1 min after intubation （T2）, 15, 30 and 60 min after pneumoperitoneum（T3-T5）, 5 min after pneumoperitoneum（T6） were recorded respectively. Time to extubation and side effects were recorded. Results In group R, the HR,MAP reached peak level at T2 or T3 （P 〈 0.05）, when CO and CI decreased to the trough level（P 〈 0.05）, CO and CI on T2, T3 was significantly decreased （P 〈 0.05）. The postoper-ative incisional pain in group D was significantly less than in group R （P 〈 0.01）. Extubation time of group D was signifi-cantly longer than that of group R （P 〈 0.01）. Conclusion Dex combined with Sev, when used in extraperi-toneal laparoscopic prostate cancer radical surgery, has no effect on hemodynamic stability during the operation, and it can reduce postoperative pain and reduce nausea and vomiting. However, the anesthesia recovery time is significantly longer.