右美托咪啶复合氟比洛芬酯对腹腔镜结直肠癌根治术患者血流动力学及苏醒期应激反应的影响

Effect of Dexmedetomidine combined with Flurbiprofen Axetil on hemodynamics and stress response during rehabilitation in patients with colorectal cancer underwent laparoscopic radical resection

目的探讨右美托咪啶复合氟比洛芬酯对腹腔镜结直肠癌根治术血流动力学及苏醒期应激反应的影响。方法选取2013年1月~2015年12月于广东省肇庆市第一人民医院行择期腹腔镜结直肠癌根治术患者78例,采用随机数字表法分三组,每组各26例。对照A组手术结束前30 min静注氟比洛芬酯50 mg;对照B组手术结束前30 min静注右美托咪定0.5μg/kg;联合组手术结束前30 min静注氟比洛芬酯50 mg+右美托咪定0.25μg/kg。于气管拔管前(T_0)、气管拔管后即刻(T_1)、气管拔管后5min(T_2)时记录平均动脉压(MAP)、心率(HR)、白介素6(IL-6)、C反应蛋白(CRP)水平,对比三组间躁动分级,记录苏醒时间、拔管时间、Ramsay镇静评分及疼痛视觉模拟评分(VAS)。结果与对照A组比较,对照B组、联合组在T_1、T_2时MAP、HR降低(P<0.05)。与对照A组、对照B组比较,联合组T_1、T_2时血清IL-6、CRP水平较低(P<0.05)。联合组躁动发生率低于对照A组、对照B组,差异有统计学意义(P<0.05)。联合组、对照A组在苏醒时间、拔管时间、Ramsay镇静评分上低于对照B组,联合组、对照B组在VAS疼痛评分上低于对照A组,差异有统计学意义(P<0.05)。结论右美托咪啶复合氟比洛芬酯有效降低腹腔镜结直肠癌根治术后的躁动现象,改善血流动力学,抑制苏醒期应激反应,且不会延长苏醒时间和拔管时间。

Objective To investigate the effect of Dexmedetomidine combined with Flurbiprofen Axetil on hemody- namics and stress response during rehabilitation in patients with colorectal cancer underwent laparoscopic radical re- section. Methods A total of 78 cases of patients with colorectal cancer underwent laparoscopic radical resection in the First People＇s Hospital of Zhaoqing City from January 2013 to December 2015 were selected and divided into three groups by random number table, each group had 26 cases. Control group A was given Flurbiprofen Axetil 50 mg 30 rain before the end of surgery; control group B was given Dexmedetomidine 0.5 μg/kg 30 min before the end of surgery; and the combination group received Flurbiprofen Axetil 50 mg combined with Dexmedetomidine 0.25 μg/kg 30 min before the end of surgery. Levels of MAP, HR, IL-6 and CRP were recorded before tracheal extubation （T0）, immediately after tra- cheal extubation （T1） and 5 min after tracheal extubation （T2）, and the grade of restlessness, recovery time, extubation time, Ramsay sedation score and VAS pain score were compared among the three groups. Results Compared with con- trol group A, the levels of MAP, HR in the control group B and the combined group at TI and T2 were decreased （P 〈 0.05）. Compared with the control group A and the control group B, the serum levels of IL-6 and CRP were lower in the combined group at TI and T2 （P 〈 0.05）. The incidence of restlessness in the combined group was lower than the control group A and the control group B （P 〈 0.05）. The recovery time, extubation time and Ramsay sedation score of the combined group and the control group A were lower than the control group B, and the VAS pain score of the combined group and the control group B was lower than the control group A（P 〈 0.05）. Conclusion Dexmedetomidine combined with Flurbipro- fen Axetil can effectively reduce restlessness after laparoscopic radical resection for colorectal cancer, improve hemo- dynamics and inhibit the stress response recovery period, and can not prolong the recovery time and extubation time.