七氟烷复合右美托咪啶用于食管癌手术的临床研究

Sevoflurane combined with dexmedetomidine for esophageal surgery

目的探讨七氟烷复合右美托咪啶吸入全身麻醉在食管癌手术中的应用和对苏醒拔管期各项指标的影响。方法选取广东省梅州市人民医院自2013年12月至2015年12月收治的90例食管癌手术患者,按照随机数字表法随机分为对照组和观察组,每组45例。两组患者均给予七氟烷进行麻醉维持,麻醉诱导前,观察组给予0.5μg/kg的右美托咪定稀释至10 ml给予微量泵输注泵输注;对照组给予相同剂量的生理盐水,输注方式同观察组,并于10 min内输注完毕。比较两组患者中心静脉压(MAP)、心率(HR)、苏醒时间、Ramsay镇静评分、躁动评分和焦虑评分(SAS)。结果观察组患者T1、T2及T3时刻HR较T0时刻明显降低,对照组T3时刻的HR和MAP较T1、T2时刻明显提高,观察组患者T1、T2、T3时刻的HR和T3时刻的MAP较对照组低,差异有统计学意义(P<0.05)。观察组患者苏醒时间比对照组缩短,Ramsay镇静评分、躁动评分和SAS评分均比对照组降低,差异有统计学意义(P<0.05)。结论于七氟烷全麻基础上加用右美托咪定应用于食管癌手术吸入全身麻醉过程中,可确保心血管的稳定性,并可缩短苏醒时间,维持镇静,减少苏醒期躁动和焦虑。

Objective To explore sevoflurane combined with dexmedetomidine used as inhaled general anaesthetic agents in the process of esophageal cancer surgery and the effect on the indicators during the period of recovery and extubation. Methods The study enrolled 90 patients who were undergoing esophageal cancer surgery in Meizhou People＇s Hospital from December 2013 to December 2015. Using random number list,patients were divided into control group and observation group with 45 patients in each group. Patients in both groups received sevoflurane anesthesia. Before anesthesia induction,the observation group received 0. 5 μg / kg dexmedetomidine which was diluted to 10 ml and infused via micro perfusor,and the control group received the same dose of saline,with the same infusion method. The infusion was completed within 10 min. Changes in mean arterial pressure（ MAP） and heart rate（ HR）,and recovery time,Ramsay sedation scale,agitation scale and anxiety scale（ SAS） were compared between two groups. Results In the observation group,HR at T1,T2 and T3 was significantly reduced compared with that at T0.In the control group,HR and MAP at T3 were significantly improved compared with those at T1 and T2. HR at T1,T2 and T3 in the observation group were lower than control group. MAP at T3 in the observation group is reduced compared with control group. The difference is statistically significant（ P〈0. 05）. The recovery time was shorter in observation group than control group. Ramsay sedation score,agitation score and SAS score were reduced and the difference is statistically significant（ P〈0. 05）. Conclusion Adding dexmedetomidine to sevoflurane as inhaled general anaesthetic agents used in the process of esophageal cancer operation ensures cardiovascular stability,shortens the recovery time,maintains calm and reduces agitation and anxiety over an emergence period.