右美托咪定预处理对食道癌根治术中血流动力学及术后镇痛的临床研究

Clinical Study of Hemodynamics and Postoperative Analgesia in Patients Undergoing Radical Resection of Esophageal Cancer by Dexmedetomidine Pretreatment

目的研究术前静脉预注射右美托咪定对食道癌根治术血流动力学及术后镇痛的影响。方法选取南阳市第一人民医院择期行食道癌根治术患者60例,采用随机数字表法分为2组,右美托咪定组(观察组)和常规对照组,观察组诱导前静脉注射右美托咪定1μg·kg-1,10 min注射完毕。记录两组入室后(TA0)、麻醉诱导后3min(TA1)、插管时(TA2)、切皮时(TA3)、拔管时(TA4)、出手术室时(TA5)的有创平均动脉压(MAP)和心率(HR),并记录术中麻醉药物的用量;记录两组入室后(TB0)、手术后2 h(TB1)、术后12 h(TB2)、术后24 h(TB3)和术后48 h(TB4)的视觉模拟评分(VAS)、疗效等级评定、安全等级评定和不良反应。结果 (1)与对照组比较,观察组TA2~TA4时点MAP和HR明显降低(均P<0.05)。与同组TA0时点比较,对照组TA2~TA4点MAP和HR明显升高(均P<0.05)。(2)与对照组比较,观察组术中丙泊酚和瑞芬太尼用量明显降低(均P<0.05)。(3)与对照组比较,观察组TB1~TB3时VAS评分明显降低(均P<0.05);观察组镇痛疗效和安全性等级优于对照组(均P<0.05),而且减少术后恶心呕吐的发生率。结论右美托咪定预处理可较好维持食道癌根治术患者术中血流动力学的稳定,能减少术中麻醉药物的用量,明显改善患者的术后镇痛疗效及减少术后恶心呕吐的发生率。

ObjectiveTo study the effect of dexmedetomidine by preoperative intravenous injection on hemodynamics and postoperative analgesia in radical resection of esophageal cancer.MethodsSixty patients underwent radical resection of esophageal cancer in Nanyang First People′s Hospital were randomly divided into two groups:the Observation group(dexmedetomidine group)and the control group.Observation group patients were given intravenous injection of dexmedetomidine1μg/kg,10min injection.The mean arterial pressure(MAP)and heart rate(HR)were recorded in the operating room(TA0),3min after induction of the anesthesia(TA1),at the time of tracheal intubation(TA2),start of surgery(TA3),at extubation(TA4)and the leaving operating room(TA5).The dosage of drugs was recorded at different time of intraoperative anesthesia.The visual analogue scales(VAS)score,therapeutic effect,safety grade and adverse reaction of the two groups were recorded after admission(TB0),2h after operation(TB1),12h(TB2),24h(TB3)and48h(TB4).Results①Compared with the control group,MAP and HR were significantly decreased in the TA2~TA4group(all P<0.05).Compared with TA0,TA2~TA4MAP and HR were significantly increased in the control group(all P<0.05).②Compared with the control group,propofol and remifentanil were significantly decreased in the observation group(all P<0.05).③Compared with the control group,the VAS score of TB1~TB3in observation group was significantly decreased(all P<0.05).The analgesic efficacy and safety grade of the observation group were better than those of the control group(all P<0.05).ConclusionDexmedetomidine pretreatment can be better to maintain hemodynamic stability in patients with radical resection of esophageal cancer,significantly improve the patient′s postoperative analgesic effect,and reduce the amount of intraoperative narcotic drugs,postoperative nausea and vomiting incidence.