右美托咪定辅助全身麻醉对胃癌根治术患者围术期血流动力学影响及术后镇静镇痛效果研究

Effect of dexmedetomidine anesthesia on hemodynamics and postoperative analgesia and sedation in patients who received radical resection of gastric cancer in the perioperative period

目的探讨右美托咪定辅助全身麻醉对胃癌根治术患者围术期血流动力学的影响及术后的镇静镇痛效果。方法将择期全身麻醉下行胃癌根治术患者72例分为对照组和观察组,每组36例。观察组患者在麻醉诱导前予以静脉泵注0.6μg·kg-1右美托咪定15 min,之后维持剂量为0.4μg·kg-1,直至手术结束前40 min停止使用。对照组患者予以等量的生理盐水。对2组患者注药前（T1）、麻醉诱导前（T2）、气管插管前即刻（T3）、插管后1 min（T4）、切皮时（T5）、探查时（T6）、拔管后即刻（T7）的心率（HR）及平均动脉压（MAP）进行观察记录,并对2组患者丙泊酚及瑞芬太尼的用量及术后1、4 h的镇静和镇痛效果进行比较。结果观察组患者T2、T4~T7时HR和MAP显著低于对照组（P〈0.05）。观察组患者丙泊酚及瑞芬太尼用量显著低于对照组（P〈0.05）。观察组患者在术后1、4 h的镇静和镇痛效果显著优于对照组（P〈0.05）。结论右美托咪定辅助全身麻醉应用于胃癌根治术患者,能够显著降低患者的应激反应,减少丙泊酚及瑞芬太尼的使用剂量,并提高术后的镇静镇痛效果。

Objective To explore the effect of dexmedetomidine anesthesia on hemodynamics and postoperative analgesia and sedation in patients who received radical resection of gastric cancer in the perioperative period. Methods Seventy-two patients who received radical resection of gastric cancer were divided into observation group and control group,with 36 cases in each group. Patients in observation group were given intravenous infusion of 0. 6 μg·kg- 1dexmedetomidine for 15 min before operation. The dose were declined to 0. 4 μg·kg- 1,and the dose were maintained at 40 min before the end of operation. Patients in control group were given the equal volume normal saline. Heart rate（ HR） and mean arterial pressure（ MAP） of patients before injection（ T1）,before induction of anesthesia（ T2）,before tracheal intubation（ T3）,1 min after tracheal intubation（ T4）,skin incision（ T5）,exploration（ T6）,after extubation（ T7） were recorded. The dosage of propofol and remifentanil of the two groups and the analgesic effect at 1 hour and 4 hours after operation were compared. Results HR and MAP of observation group were significantly lower than control group at T2,T4to T7（ P 0. 05）. The dosage of propofol and remifentanil of observation group were significantly lower than control group（ P 0. 05）. The visual analogue scales score and Ramsay sedative score of observation group were better than those of control group at 1 hour and 4 hours after operation（ P 0. 05）. Conclusion Dexmedetomidine anesthesia decreases significantly stress reaction and the dosage of propofol and remifentanil in patients who received radical resection of gastric cancer,and improves the effect of analgesia and sedation.