右美托咪定和丙泊酚在结肠癌根治术麻醉中的应用效果比较

Effect of dexmedetomidine and propofol anesthesia in the surgical anesthesia of colon cancer

目的比较右美托咪定和丙泊酚在结肠癌根治术麻醉中的应用效果。方法全麻下行结肠癌根治术患者60例,随机分为两组,30例患者以右美托咪定(观察组)镇痛镇静,30例术中给予丙泊酚(对照组)维持镇痛镇静。观察组给以静脉泵注0.6μg/kg右美托咪定,20min后,速度调至0.4μg/kg,距手术结束30min停止使用。对照组给以静脉泵注2.5mg/kg丙泊酚,手术结束前10min停止使用丙泊酚。术中对两组患者给药前(T_1)、诱导前(T_2)、插管前即刻(T_3)、插管成功1min (T_4)、切皮(T_5)、手术牵拉(T_6)、拔管后(T_7)的心率(HR)、呼吸频率(RR)及平均动脉压(MAP)进行观察记录,并对两组患者瑞芬太尼和七氟醚的用量及术后1、4h的镇痛镇静效果进行比较。结果观察组T_2～T_7时HR和MAP显著低于对照组,且观察组术中使用瑞芬太尼及七氟醚的药量对比对照组结果为显著降低,术后观察组的镇痛镇静效果比对照组更加理想(均P<0.05)。结论右美托咪定在结肠癌根治术中的镇痛镇静效果明显优于丙泊酚,能使患者的应激反应明显降低,并且减少瑞芬太尼及七氟醚的使用量,提高了手术后的镇痛镇静效果。

Objective To compare the effect of dexmedetomidine and propofol in the surgical anesthesia of colon cancer.Methods Sixty patients were treated with radical resection of colon cancer under general anesthesia,and were divided into two groups by random lottery.Thirty patients were treated with dexmedetomidine(observation group)for analgesic and sedation,and thirty patients were treated with propofol(control group)for maintenance analgesic and sedation.In the observation group,patients were given 0.6μg/kg dexmedetomidine by intravenous injection,after 20 minutes,the velocity was adjusted to 0.4μg/kg and the use was discontinued 30 minutes after the operation.In the control group,patients were given 2.5 mg/kg propofol by intravenous pump injection,and the use was stopped 10 minutes before the operaticon.Before dosing(T1),before the induction(T2),immediately before intubation(T3),1 min successful intubation(T4),cut skin(T5),surgery pull(T6),after extubation(T7)of patients in two groups of fentanyl and sevoflurane and postoperative analgesia sedative effects of 1,4 hwere compared in the two groups.Results HR and MAP of the observation group were significantly lower than those of the control group from T2 to T7,and the intraoperative dose of remifentanil and sevoflurane in the observation group was significantly lower than that in the control group,the analgesia and sedation effect of the observation group was more ideal than that of the control group(all above P<0.05).Conclusion The analgesic and sedation effect of dexmedetomidine in the radical operation of colon cancer is obviously superior to propofol,which can significantly reduce the stress response of patients,reduce the use of remifentanil and sevoflurane,and improve the analgesic and sevoflurane after operation.