右美托咪定对肺癌根治术围手术期应激反应的影响研究

Study on the effect of dexmedetomidine on perioperative stress reaction in radical resection of lung cancer

目的:探讨右美托咪定对肺癌根治术围手术期应激反应的影响。方法:选取接受胸腔镜下肺癌根治术治疗的肺癌患者46例作为研究对象,将患者随机分为观察组(n=23)与对照组(n=23)。观察组患者在麻醉过程中增加右美托咪定辅助麻醉,而对照组不用。比较两组患者麻醉诱导前(t_0)、气管插管完成时(t_1)、手术进行1 h(t_2)、手术结束时(t_3)以及气管插管拔管时(t_4)应激反应及血流动力学指标的变化,并比较气管拔管后镇静情况。结果:两组患者平均动脉血压(MAP)、心率(HR)在t_1、t_4时点显著高于T0,差异均有统计学意义(P<0.05);观察组患者MAP、HR在t_1、t_4时点显著低于对照组(P<0.05);在t_1、t_2、t_4时点,两组患者血浆去甲肾上腺素、肾上腺素、皮质醇均显著高于t_0时点,且观察组水平均显著低于对照组,差异均有统计学意义(P<0.05);气管拔管后5 min,观察组患者Ramsay镇静评分明显高于对照组(P<0.05)。结论:右美托咪定辅助麻醉可以有效减轻肺癌根治术围手术期的应激反应程度,对维持血流动力学的稳定及术后恢复有利。

Objective： To discuss the effect of dexmedetomidine on perioperative stress reaction in radical resection of lung cancer. Methods： 46 cases of lung cancer patients treated with thoracoscopic radical resection of lung cancer were selected as the research object,divided into observation group（ n = 23） and control group（ n = 23） randomly. the observation group was combined with application of dexmedetomidine in anesthesia,but the control group without dexmedetomidine,the changes of stress response and hemodynamics at before induction（ t0）,gas tube intubation（ t1）,surgery for 1H（ t2）,the end of operation（ t3） and pull out tracheal intubation tube（ t4） in the patients of two groups were compared,and the situation of sedation after tracheal extubation was compared. Results： The MAP and HR at t1 and t4was significantly higher than that of t0 in both groups,the difference was statistically significant（ P〈0. 05）; the MAP,HR in observation group was significantly lower than these in the control group at t1,t4,the differences was statistically significant（ P〈0. 05）; The plasma norepinephrine,epinephrine and cortisol at t1,t2,t4 in both groups were significantly higher than these at t0,and the level of observation group was significantly lower than that of the control group,the differences were statistically significant（ P〈0. 05）; after 5min of tracheal extubation,the Ramsay sedation score in observation group was significantly higher than that in the control group（ P〈0. 05）. Conclusions： Dexmedetomidine assisted anesthesia can effectively alleviate perioperative stress reaction in radical resection of lung cancer,and is of benefit for maintain the stability of hemodynamics and postoperative recovery.