胃癌根治术中右美托咪定辅助全身麻醉对患者围术期血流动力学、麻醉药用量以及术后镇静镇痛的影响

Effect of dexmedetomidine assisted anesthesia on perioperative hemodynamics, anesthetic dosage, and postoperative sedation and analgesia in patients undergoing radical gastrectomy

目的分析胃癌根治术中右美托咪定辅助全身麻醉对患者围术期血流动力学、麻醉药用量以及术后镇静镇痛的影响.方法选择2016-01/2017-12在华中科技大学同济医学院附属同济医院接受全麻状态下行胃癌根治术的60例患者作为研究对象.采用随机数字表法将纳入患者随机地分为两组,即试验组和对照组,每组各30例患者.试验组采用右美托咪定输注,而对照组采用等量的生理盐水输注.比较两组患者注药前(T_0)、麻醉诱导前(T_1)、插管前(T_2)、插管后即刻(T_3)、插管后3 min(T_4)、拔管后即刻(T_5)、拔管后3 min(T_6)血流动力学指标、镇静镇痛效果、肾上腺素及去甲肾上腺素水平及麻醉药物用量等.结果T_1时观察组患者BIS值显著低于T_0及对照组(76.3±3.9 vs 94.1±2.8),差异具有统计学意义(P<0.05),T_1、T_3、T_5时,对照组患者的MAP、HR均显著高于观察组患者(P<0.05).T_3、T_5时,对照组患者的E、NE浓度均显著高于T_2及观察组(P<0.05),观察组变化不显著(P>0.05).术后1 h与4 h,观察组患者的VAS评分均显著低于对照组患者(1.3±0.6 vs 2.6±1.1,1.6±0.6vs 2.1±1.8),差异具有统计学意义(P<0.05);观察组Ramsay评分均显著高于对照组患者(3.4±1.0 vs 1.8±0.8,2.6±0.6 vs 1.9±0.7),差异具有统计学意义(P<0.05).对照组患者丙泊酚(1421.6±328.6)、瑞芬太尼(5.3±1.3)用量均显著高于观察组(1009.8±209.4,3.2±1.2),差异具有统计学意义(P<0.05).结论胃癌根治术中使用右美托咪定能够有效降低血流动力学波动及肾上腺素、去甲肾上腺素水平的改变,降低了麻醉药物用量,减少患者术后的不适与痛苦,为患者提供了良好的镇痛镇静作用.

AIM To analyze the effect of dexmedetomidine assisted anesthesia on perioperative hemodynamics, anesthetic dosage, and postoperative sedation and analgesia in patients undergoing radical gastrectomy.METHODS Sixty patients who underwent radical gastrectomy under general anesthesia at Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2016 to December 2017 were included. The patients were randomly divided into an experimental group and a control group, with 30 patients in each group. In the experimental group, dexmedetomidine infusion was used, while the control group was given equal amount of saline infusion. Hemodynamics, anesthetic dosage, epinephrine norepinephrine and parathyroid hormone levels, and sedative and analgesic effects were compared between the two groups of patients before injection （T0）, before induction of anesthesia （T1）, before intubation （T2）, immediately after intubation （T3）, 3 min after intubation （T4）, immediately after extubation （T5）, and 3 rain after extubation （T6）.RESULTS The BIS value of the observation group at T1 was significantly lower than that at T0 group and that of the control group （76.3±3.9 vs 94.1±2.8, P 〈 0.05）. At T1, T3, and T5, the MAP and HR of the control group were significantly higher than those of the observation group （P 〈 0.05）. At T3 and T5, the concentrations of E and NE in the control group were significantly higher than those at T2 and those of the observation group （P 〈 0.05）, although the changes in the observation group were not significant （P 〉 0.05）. At I and 4 h after surgery, the VAS scores in the observation group were significantly lower than those in the control group （1.3±0.6 vs 2.6±1.1, 1.6±0.6 vs 2.1±1.8, P 〈 0.05）, and the Ramsay scores in the observation group were significantly higher than those in the control group （3.4±1.0 vs 1.8±0.8, 2.6±0.6 vs 1.9±0.7, P 〈 0.05）. The doses of propofol （1421.6±328.6） and remifentanil （5.3±1.3） in the control group were significantly higher than those in the observation group （1009.8±209.4 and 3.2±1.2, respectively; P 〈 0.05）.CONCLUSION Dexmedetomidine assisted anesthesia can effectively reduce the fluctuation of hemodynamic parameters and the kinetics of epinephrine and norepinephrine, decrease the amount of narcotic drugs used, reduce postoperative discomfort and pain, and provide good sedation in patients undergoing radical gastrectomy.