帕瑞昔布钠与右美托咪定联用对开胸手术患者血糖胰岛素血皮质醇及应激反应的影响

Curative Effect of Parecoxib Sodium Combined with Dexmedetomidine on the Blood Glucose Insulin Cortisol and Stress Response of Patients underwent Thoracic Surgery

目的:研究帕瑞昔布钠与右美托咪定联用对开胸手术患者血糖、胰岛素、血皮质醇及应激反应的影响。方法:选取2014年4月至2015年4月我院接诊的80例行开胸手术患者作为本次研究对象,并将其按照抽签法分为观察组和对照组,每组40例。对照组术前30min给予40mg帕瑞昔布钠静脉注射,观察组术前半小给予40mg帕瑞昔布钠,手术结束前5min采用缓慢注射右美托咪定0.5μg/kg。观察和比较两组患者术中出血量、术中输血量、呼吸恢复时间、苏醒时间、拔管时间,麻醉诱导前(T0)、术毕(T1)、拔除气管导管后即刻(T2)血糖、胰岛素、血皮质醇、肾上腺素、去甲肾上腺素、平均动脉压(MAP)、心率(HR)、呼吸率(RR)、视觉模拟评分法(VAS)、镇静评分(Ramsay)的变化。结果:两组患者术中出血量、术中输血量、呼吸恢复时间、苏醒时间、拔管时间比较差异均无统计学意义(P>0.05);观察组T1、T2时血糖、胰岛素、血皮质醇水平显著低于对照组[(5.04±0.74)mmo L/L vs(6.83±0.75)mmo L/L,(6.73±0.61)mmo L/L vs(7.69±0.83)mmo L/L,(15.59±1.89)μIU/m L vs(20.86±2.03)μIU/m L,(14.93±1.82)μIU/m L vs(17.53±1.94)μIU/m L,(370.26±62.07)nmo L/L vs(560.49±70.53)nmo L/L,(402.86±63.75)nmo L/L vs(694.27±78.36)nmo L/L](P<0.05);T1、T2时肾上腺素、去甲肾上腺素水平显著低于对照组[(48.28±16.20)ng/m L vs(79.36±18.37)ng/m L,(77.39±18.20)ng/m L vs(96.38±19.75)ng/m L,(316.25±43.55)ng/m L vs(402.17±53.47)ng/m L,(398.46±54.32)ng/m L vs(475.62±56.29)ng/m L](P<0.05);T1、T2时MAP、HR显著小于对照组[(77.34±6.19)mm Hg vs(84.59±6.12)mm Hg,(76.40±5.89)mmHg vs(81.49±5.97)mm Hg,(89.80±9.46)次/min vs(95.70±9.80)次/min,(87.57±8.09)次/min vs(94.45±8.90)次/min](P<0.05);VAS、Ramsay评分均显著低于对照组[(2.56±0.35)分vs(5.30±0.78)分,(3.63±0.90)分vs(6.42±1.08)分](P<0.05)。结论:帕瑞昔布钠与右美托咪定具有相互协作的作用,能够降低血糖、胰岛素、血皮质醇,不会造成较大的应激反应,可显著缓解患者的疼痛,降低躁动情况,有利于改善患者的预后。

Objective:To study the curative effect of parecoxib sodium combined with dexmedetomidine on the blood glucose,insulin,cortisol and stress response of patients underwent thoracic surgery.Methods:80 patients of thoracic surgery who were treated from April 2014 to April 2015 in our hospital were selected as research objects.According to the draw method,these patients were divided into the observation group and the control group,40 cases in each group.The control group was treated with 40mg parecoxib sodium through intravenous injection at half an hour before operation,while the observation group was treated with slow injection of dexmedetomidine 0.5μg/kg at 5 minutes before the end of operation.The intraoperative hemorrhage and blood transfusion volume,recovery time of breath,waking time,extubation time,the changes of blood glucose,insulin,cortisol,epinephrine and norepinephrine,mean artery pressure(MAP),heart rate(HR),respiration rate(RR),visual analogue scale/score(VAS),ramsay score before induction(T 1),at the end of operation(T 2)and immediately after extubation were compared between two groups.Results:There was no significant difference in the intraoperative blood loss,intraoperative blood transfusion,recovery time,recovery time of breath and extubation time between the two groups(P>0.05);the blood glucose,insulin and cortisol levels in the observation group at T 1,T 2 were significantly lower than those of the control group[(5.04±0.74)mmol/L vs(6.83±0.75)mmol/L,(6.73±0.61)mmol/L vs(7.69±0.83)mmol/L,(15.59±1.89)μIU/mL vs(20.86±2.03)μIU/mL,(14.93±1.82)μIU/mL vs(17.53±1.94)μIU/mL,(370.26±62.07)nmol/L vs(560.49±70.53)nmol/L,(402.86±63.75)nmol/L vs(694.27±78.36)nmol/L](P<0.05);the epinephrine and norepinephrine levels at T1,T2 were significantly lower than those of the control group[(48.28±16.20)ng/mL vs(79.36±18.37)ng/mL,(77.39±18.20)ng/mL vs(96.38±19.75)ng/mL,(316.25±43.55)ng/mL vs(402.17±53.47)ng/mL,(398.46±54.32)ng/mL vs(475.62±56.29)ng/mL](P<0.05);the MAP,HR at T 1,T 2 were significantly lower than those of the control group[(77.34±6.19)mmHg vs(84.59±6.12)mmHg,(76.40±5.89)mmHg vs(81.49±5.97)mmHg,(89.80±9.46)time/min vs(95.70±9.80)time/min,(87.57±8.09)time/min vs(94.45±8.90)time/min](P<0.05);VAS,Ramsay scores were significantly lower than those of control group[(2.56±0.35)score vs(5.30±0.78)score,(3.63±0.90)score vs(6.42±1.08)score](P<0.05).Conclusion:Parecoxib sodium and dexmedetomidine had a synergic role,it could reduce the blood glucose,insulin,cortisol,relieve the pain,relieve restlessness,but wouldn't cause greater stress response and was conducive to the prognosis of patients.