右旋美托咪定复合瑞芬太尼用于老年高血压患者腹腔镜结肠癌根治术的临床观察

Clinical observation of colon cancer radical surgery by laparoscopic with dexmedetomidine and remifentanil in elderly hypertensive patients

目的观察右旋美托咪定复合瑞芬太尼对老年高血压腹腔镜结肠癌根治术患者围麻醉期血流动力学及不良反应的影响。方法 60例老年高血压拟施腹腔镜结肠癌根治术的患者随机分为右旋美托咪定1组(D1组)、右旋美托咪定2组(D2组)和对照组(C组),每组20例。麻醉诱导前10 min,D组泵注右旋美托咪定0.8μg/kg,然后D1组、D2组分别以0.4μg/(kg·h)和0.2μg/(kg·h)持续泵注至术毕,同期C组给予等量生理盐水。常规诱导,术中用七氟醚、瑞芬太尼和罗库溴铵维持麻醉。分别记录进入室时(T0)、给药后5 min(T1)、插管即时(T2)、插管后1 min(T3)、插管后5 min(T4)、手术切皮时(T5)、手术开始30 min(T6)、拔管即时(T7)和拔管后5 min(T8)的平均动脉压和心率,术中血压>180/100 mmHg给予盐酸乌拉地尔注射液25 mg,心率>110 bpm给予盐酸艾司洛尔注射液20 mg,同时观察苏醒期躁动评分和镇静评分以及苏醒时间。结果三组入室的平均动脉压和心率无显著差异(P>0.05);D1组和D2组在给药后5 min、插管即时、插管后1 min、插管后5 min、手术切皮时、手术开始30 min、拔管即时和拔管后5 min的平均动脉压和心率显著低于C组(P<0.05);C组拔管后5min的平均动脉压和心率仍显著高于D组(P<0.05);C组的躁动评分显著高于D1和D2组(P<0.05);C组的镇静评分显著低于D1和D2组(P<0.05);D1组的苏醒时间显著高于D2组和C组。结论右旋美托咪定复合瑞芬太尼能够减轻老年高血压腹腔镜结肠癌根治术患者诱导期和苏醒期的不反应,术中血流动力学更平稳,0.2μg/(kg·h)复合瑞芬太尼持续泵注是较理想的选择。

Objective To observe the effects of anesthesia with dexmedetomidine and remifentanil in elderly hypertensive patients undergoing laparoscopic colon resection hemodynamic. Methods 60 cases of laparoscopic colon cancer in elderly hypertensive patients intended to impose radical surgery were randomly divided into dexmedetomidine group 1 （group Dt ） , dexmedetomidine group 2 （group D2 ） , and the control group （group C） ,20 cases in each group. At 10 rain before induction of anesthesia, group D was given dexmedetomidine infusion, 0, 8 μg/kg, and then group D1 , D2 respectively was given 0. 4 μg/（ kg- h ） and 0. 2 μg/（ kg· h） continuous infusion. And the group C was given normal saline at the same time. Conventional induction, sevoflurane, remifentanil and rocuronium were used to maintain anesthesia. The mean arterial pressure and heart rate were recorded at the time that into the chamber （ TO ） , after admin- istration 5 min （ Tt ） , intubated immediately （ T2 ） , after intubation 1 min （ T3 ） , after intubation 5 min （ T4 ） , surgical skin incision （ T5 ） , the beginning of surgery 30 rain （ T6, ） , immediate extubation （ T7 ） and after extubation 5 rain （T8）. When intraoperative blood pressure 〉 180/100 mmHg,urapidil hydrochloride injection was given,25 mg, when heart rate 〉 110 bpm,esmolol hydrochloride injection was given,20 rag. The restlessness score, sedation score and re- covery time were observed. Results The mean room entrance arterial pressure and heart rate of the three groups had no significant difference （P 〉 0. 05 ） ;the mean arterial pressure and heart rate of group Di and D2 after administration 5 min,intubated immediately after intubation 1 rain, after intubation 5 min, surgical incision,the surgery begins 30 min, 5 min after extubation extubation immediate, were significantly lower than those of group C （ P 〈 0. 05 ） ; the mean arte- rial pressure and heart rate of group C at 5 minutes after extubation remained significantly higher than that of group D （ P 〈 0. 05 ） ; agitation score of group C was significantly higher than that of group D1 and group D2 （ P 〈 0. 05 ） ; seda- tion scores of group C were significantly lower than those of group DI and group D2 （P 〈 0. 05 ） ;the recovery time of group DI was significantly higher than that of group D2 and group C. Conclusion Dexmedetomidine and remifentanil can reduce colon cancer in elderly hypertensive patients undergoing laparoscopic induction period and the emergence of non-reactive, more stable hemodynamics ,0. 2μg/（kg·h） continuous infusion of remifentanil is the ideal choice.