围术期应用右美托咪定对结肠癌根治术后肠麻痹的影响

Effect of perioperative administration of dexmedetomidine on postoperative ileus after laparocolectomy

目的探讨围术期应用右美托咪定对结肠癌根治术后肠麻痹的影响。方法择期行腹腔镜下结肠癌根治术男性患者60例,采用随机数字表法将其分为两组,每组30例。D组在全麻诱导前10min内静脉输注右美托咪定0.6μg/kg,术中以0.5μg·kg-1·h-1的速率输注至术毕前30min。C组采用同样方法静脉输注等量生理盐水。C组和D组分别予以舒芬太尼2μg/kg以及舒芬太尼2μg/kg＋右美托咪定2μg/kg行静脉术后镇痛。记录输注右美托咪定前（T0）、气管插管后10min（T1）、气腹后10min（T2）、气腹后1h（T3）、气腹结束后10min（T4）以及拔管后10min（T5）的心率变异性（HRV）;于T0、T3、T5、术后12h（T7）、术后48h（T10）静脉采血测定肾上腺素（E）和去甲肾上腺素（NE）浓度;记录术后第一次排气以及进食时间。结果与T0时比较,C组在T1~T4时以及D组在T1~T5时HRV总功率频段（TP）、高频段（HF）、低频段（LF）、低频/高频（LF/HF）明显降低,两组在T3、T5、T7及T10时E和NE浓度明显升高（P〈0.05）。与T1时比较,C组在T2~T4时TP、LF及LF/HF明显升高（P〈0.05）。与C组比较,D组在T2~T5时TP、LF及LF/HF明显降低,在T3、T5、T7、T10时E和NE浓度明显降低,术后第一次排气时间明显缩短（P〈0.05）。结论围术期应用右美托咪定可促进结肠癌根治术后胃肠功能恢复,缩短肠麻痹时间。

Objective To evaluate the effect of perioperative administration of dexmedetomidine on postoperative ileus after laparocolectomy.Methods Sixty patients scheduled for abdominal surgery were randomly divided into two groups,30 in each group.Group D received dexmedetomidine administeration at a loading dose of 0.6μg/kg for 10 minutes before induction,followed by an infusion rate of 0.5μg·kg-1·h-1 to 30 min before the end of surgery.The control group received saline instead of Dex.After the surgery,Group C received intravenous sufentanyl 2μg/kg,while group D sufentanyl 2μg/kg combined with Dex 2μg/kg.Heart rate variability（HRV）were detected before Dex infusion（T0）,10 minutes after intubation（T1）,10 minutes after CO2insufflation（T2）,1hour after CO2insufflation（T3）,10 minutes after CO2desufflation（T4）,and 10 minutes after extubation（T5）.The plasma concentrations of epinephrine（E）and norepinephrine（NE）were determined at T0,T3,T5,T7 and T10.The recovery of bowel function was evaluated in terms of the first time to fart and intake food.Results Compared with T0,HRV of power（TP）,high-frequency（HF）power,low-frequency（LF）power and the ratio of LF/HF power were significantly decreased at T1-T4 in group C and at T1-T5 in group D.The plasma concentrations of E and NE were higher at T3,T5,T7 and T10in both group C and group D（P〈0.05）.Compared with T1,TP,LF and the ratio of LF/HF were increased at T2-T4（P〈0.05）.Compared with group C,TP,LF and the ratio of LF/HF were decreased at T2-T5,The plasma concentrations of E and NE were decreased at T3,T5,T7 and T10and the time of first flatus was earlier（P〈0.05）.Conclusion The perioperative administration of dexmedetomidine during laparocolectomy facilitated the early recovery of bowel function after surgery and decreasede the time of postoperative ileus.