右美托咪定剂量对全麻下结直肠癌术中体征及术后并发症的影响

Effect of different dose of dexmedetomidine on intraoperative signs and postoperative complications in patients undergoing operation for colorectal cancer under general anesthesia

目的探讨右美托咪定（Dex）剂量对全麻下结直肠癌术中体征及术后相关并发症的影响。方法纳入择期全麻下腹腔镜结直肠癌手术患者112例,ASAⅠⅢ级,随机分为低剂量组（D1组）、中剂量组（D2组）、高剂量组（D3组）和对照组各28例,D1组、D2组、D3组麻醉诱导前给予Dex负荷剂量0.5μg/kg,术中分别以0.2、0.5、0.8μg/kg·h速度输注,术毕前30 min停止;对照组术中静脉给予等容量0.9%氯化钠注射液。记录各组用药前（t0）、插管前1 min（t1）、插管后1 min（t2）、拔管前1 min（t3）、拔管后1 min（t4）血流动力学变化;记录自主呼吸时间、睁眼时间、拔管时间、麻醉后监测治疗室（PACU）观察时间及术后相关并发症发生率。结果与t0相比,Ⅳ组t1、t2、t4时间点心率（HR）、收缩压（SBP）、舒张压（DBP）均明显上升（均P<0.05）;与对照组对比,D1组、D2组、D3组t2、t4时间点HR、SBP、DBP均明显较低（均P<0.05）。与对照组对比,D1组、D2组、D3组术后自主呼吸恢复时间、睁眼时间、拔管时间和PACU观察时间明显缩短（均P<0.05）;与D3组对比,D1组、D2组术后自主呼吸恢复时间、睁眼时间、拔管时间和PACU观察时间明显缩短（均P<0.05）。与对照组对比,D2组、D3组认知功能障碍（POCD）、谵妄发生率明显降低（均P<0.05）;与D3组对比,D1组的POCD、谵妄发生率明显降低（均P<0.05）。结论右美托咪定能够维持全麻下结直肠癌手术患者血流动力学稳定,但0.5μg/kg·h的速度输注能够缩短术后清醒时间,降低术后POCD、谵妄发生率。

Objective To investigate the effects of different dose of dexmedetomidine(Dex) on intraoperative signs and postoperative complications in patients undergoing operation for colorectal cancer under general anesthesia.Methods One hundred and twelvepatients with ASA gradeⅠ-Ⅲwho underwent laparoscopic operation for colorectal cancer under general anesthesia were included in the study.Patients were randomly assigned to low dose group(group D1),middle dose group(group D2),high dose group(group D3),and control group with 28 cases in each group.Patients in group D1,D2 and D3 were given loading dose(0.5 mu g/kg) of Dex.During the operation,they were treated with 0.2,0.5,and 0.8 μg/kg·h,respectively,till 30 min before operation.Patients in control group were intravenously injected with same volume of 0.9% sodium chloride injection.The changes of blood flow before medication(t0),1min(t1) before intubation,1min after intubation(t2),1min before extubation(t3),and 1min after extubation(t4) were recorded.The time of spontaneous breathing,eye opening time,extubation time,observation time in Post Anesthesia Care Unit(PACU),and incidence of postoperative complications were recorded.Results Compared with those at t0,heart rate(HR),systolic blood pressure(SBP) and diastolic blood pressure(DBP) at t1,t2 and t4 were significantly higher(P <0.05).Compared with those in the control group,HR,SBP and DBP in group D1,D2 and D3 at t2 and t4 were significantly lower(P <0.05).Compared with that of the control group,time of spontaneous breathing,eye opening time,extubation time and observation time in PACU of group D1,D2 and D3 was significantly shorter(P < 0.05).Compared with those in group D3,spontaneous breathing time,time to eye opening,extubation time,and PACU observation time in group D1 and D2 were significantly shorter(P <0.05).Compared with those in control group,the incidence rates of postoperative cognitive dysfunction(POCD) and delirium in group D2 and D3 were significantly lower(P <0.05).Compared with those in group D3,the incidence rates of POCD and delirium in group D1 were significantly lower(P <0.05).Conclusions Dexmedetomidine can maintain the stability of hemodynamics in patients undergoing operation for colorectal cancer under general anesthesia.The injection speed of 0.5μg/kg·h can shorten the the post-operative awake time and reduce the incidence rates of post-operative POCD and delirium.