右美托咪定在老年患者腹腔镜胃癌术后的应用效果

Application effect of Dexmedetomidine on postoperative laparoscopic gastric cancer in elderly patients

目的探讨右美托咪定在老年患者腹腔镜胃癌术后的应用效果。方法选取2016年1月～2017年12月在我院实施腹腔镜胃癌根治术的80例老年患者作为研究对象,根据随机信封法将其分为右美托咪定组(D组)与对照组(C组),每组各40例。D组患者在15 min内给予右美托咪定1μg/kg,之后以0.4μg/kg静脉泵注,C组患者在相同时间给予同等容积的生理盐水。所有患者均采用硬膜外麻醉复合全凭静脉麻醉,多模式术后镇痛。比较两组患者的手术时间、术中输液量、麻醉药用量、住院时间、术后恶心呕吐发生情况、术后炎性反应程度[C反应蛋白(CRP)、白介素-6(IL-6)、红细胞沉降率(ESR)、中性粒细胞百分比(N)]及术后功能恢复情况(PQRS)[情感模块(ED)、伤害性刺激模块(ND)、认知功能模块(CD)、整体术后功能恢复(OPR)]。结果两组患者的手术时间、术中输液量比较,差异无统计学意义(P>0.05);D组患者的丙泊酚、舒芬太尼用量均少于C组,住院时间短于C组,术后恶心呕吐发生率低于C组,差异有统计学意义(P<0.05)。两组患者术后各时间点的CRP及N比较,差异无统计学意义(P>0.05);D组患者术后各时间点的ESR、IL-6水平均低于C组,差异有统计学意义(P<0.05)。D组患者术后各时点的ED、ND、CD、OPR值均显著高于C组,差异有统计学意义(P<0.01)。结论右美托咪定在老年患者腹腔镜胃癌术后应用能明显减少患者麻醉药用量,缩短住院时间,减轻术后炎症反应,有利于术后功能恢复。

Objective To investigate the application effect of Dexmedetomidine on postoperative laparoscopic gastric cancer in elderly patients.Methods From January 2016 to December 2017,a total of 80 elderly patients who underwent laparoscopic radical gastrectomy for gastric cancer were selected as objects and divided into the Dexmedetomidine group(group D)and the control group(group C)according to the random envelope method,with 40 cases in each group.Group D received Dexmedetomidine 1μg/kg within 15 min,and then received that 0.4μg/kg,while group C received the same volume of physiological saline.All patients were anesthetized with epidural anesthesia combined with intravenous anesthesia and received postoperative multimodal analgesia.The operation time,intraoperative fluid volume,anesthetic dose,length of hospital stay,postoperative nausea and vomiting,postoperative inflammatory response(C-reactive protein[CRP],interleukin-6[IL-6],erythrocyte sedimentation rate[ESR],neutrophil percentage[N]),and postoperative functional recovery(PQRS)(emotive domain[ED],nociceptive domain[ND],cognitive domain[CD],overall postoperative function recovery[OPR])were compared between the two groups.Results There were no significant differences in the operation time and intraoperative fluid volume between the two groups(P>0.05).The doses of Propofol and Sufentanil in the group D were less than those in the group C,the hospital stay was shorter than that in the group C,the rate of postoperative nausea and vomiting was lower than that in the group C,and the differences were statistically significant(P<0.05).There were no significant differences in CRP and N at each time point after surgery between the two groups(P>0.05).The ESR and IL-6 levels at each time point after surgery in the group D were lower than those in the group C,and the differences were statistically significant(P<0.05).The values of ED,ND,CD and OPR at each time point after surgery in the group D were significantly higher than those in the group C,and the differences were statistically significant(P<0.01).Conclusion The application of Dexmedetomidine in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer can significantly reduce the dosage of anesthetic,shorten the hospitalization time,reduce the postoperative inflammatory response,and facilitate postoperative functional recovery.