右美托咪啶复合丙泊酚或七氟烷全麻对胃肠肿瘤腹腔镜手术患者应激和术后恢复质量的影响

Effect of Dexmedetomidine Combined with Propofol or Sevoflurane General Anesthesia on Stress and Postoperative Quality of Recovery(QoR-40) in Patients Undergoing Laparoscopic Surgery

目的探讨右美托咪啶复合丙泊酚或七氟烷全麻对胃肠肿瘤腹腔镜手术患者应激和术后恢复质量的影响。方法选取2016年3月至2018年1月河南省肿瘤医院200例拟行腹腔镜胃肠肿瘤切除术患者(胃肿瘤、结肠肿瘤各100例),随机数字表法分为SP组(胃肿瘤手术+丙泊酚全麻50例)、SS组(胃肿瘤手术+七氟烷全麻50例)、CP组(结肠肿瘤手术+丙泊酚全麻50例)、CS组(结肠肿瘤手术+七氟烷全麻50例)4组,均采用右美托咪啶、依托咪酯、舒芬太尼、顺式阿曲库铵麻醉诱导,SP组、CP组给予丙泊酚麻醉维持,SS组、CS组给予七氟烷麻醉维持,统计对比各组手术情况、苏醒质量,并记录T0(麻醉开始前)、T1(手术开始后30 min)、T2(气管导管拔出后10 min)、T3(术后24h)、T4(术后48 h)各时点患者心率、平均动脉压,检测各时点去甲肾上腺素、皮质醇水平,采用术后恢复问卷表(QoR-40)评估术后24、48 h恢复质量。结果4组患者手术时间、出血量等手术情况差异均无统计学意义(均P>0.05);T0~T4时点4组心率、平均动脉压差异均无统计学意义(均P>0.05)。T1、T2时点4组去甲肾上腺素、皮质醇水平差异均有统计学意义(F=54.135、140.733、12.037、21.644,均P<0.05);T1、T2时点SP组去甲肾上腺素、皮质醇小于SS组(均P<0.05),CP组小于CS组(均P<0.05);其余时点4组间差异均无统计学意义(均P>0.05)。SP组VAS及RS评分分别为(0.9±0.4)、(0.8±0.4)分,均低于SS组的(1.4±0.5)、(1.4±0.5)分,恢复意识时间为(9.3±1.4)min,短于SS组的(10.1±1.4)min,差异均有统计学意义(均P<0.05);CP组VAS及RS评分分别为(0.8±0.5)、(0.8±0.4)分,低于CS组的(1.4±0.5)、(1.4±0.4)分,恢复意识时间为(9.2±1.2)min,短于CS组的(10.1±1.2)min,差异均有统计学意义(均P<0.05);SP组术后24h恢复质量评分为(164±11)分,大于SS组的(146±10)分,CP组术后24h恢复质量评分为(168±11)分,大于CS组的(143±12)分,差异均有统计学意义(均P<0.05)。结论右美托咪啶复合丙泊酚应用于胃肠肿瘤腹腔镜手术患者能有效减轻术中应激,降低术后疼痛、躁动程度,提高术后恢复质量。

Objective To explore the effects of dexmedetomidine combined with propofol or sevoflurane general anesthesia on stress and postoperative quality of recovery (QoR-40) in patients undergoing laparoscopic surgery.Methods Two hundreds patients with laparoscopic gastrointestinal tumor resection (100 cases of gastric tumor and 100 cases of colon tumor) from March 2016 to January 2018 at Henan Cancer Hospital,were randomly divided into 4 groups(n=50): group SP (gastric neoplasm + propofol anaesthesia),group SS (gastric tumor + sevoflurane anaesthesia),group CP (colon tumor+ propofol anaesthesia),and group CS (colon tumor + sevoflurane anaesthesia).The four groups were all induced by dexmedetomidine,etomidate,sufentanil and cisatracurium.The patients in group SP and group CP were administered with propofol,and the patients in group SS and group CS were given general anesthesia with sevoflurane.The results of the operation and the quality of recovery were compared.The heart rate,mean arterial pressure change,norepinephrine,epinephrine and cortisol were measured in T0 (before anesthesia started),T1 (30 min after surgery),T2 (10 min after tracheal catheter extraction),T3 (24 h after surgery),T4 (postoperative 48 h),respectively.The postoperative recovery quality after operation was evaluated by QoR-40.Results There were no significant differences in operation time,bleeding volume and other operation conditions between each group (all P>0.05),and also no significant differences in heart rate and mean arterial pressure from T0 to T4 time points (all P>0.05).There were significant differences in the levels of norepinephrine and cortisol among the four groups at T1 and T2 time points (F=54.135,140.733,12.037,21.644,all P<0.05).The levels of norepinephrine and cortisol in SP group at T1 and T2 time points were less than SS group (all P<0.05).Similar,those in CP group were less than CS group (P<0.05).However,there was no significant difference among the 4 groups at other time points (all P>0.05).The scores of VAS and RS in SP group were (0.9±0.4) and (0.8±0.4),which were lower than that of SS group(1.4±0.5,1.4±0.5,all P<0.05).At the same time,the time of regain consciousness was (9.3±1.4) min,which was also lower than SS group [(10.1±1.4)min,P<0.05].The scores of VAS and RS in CP group were (0.8±0.5) and (0.8±0.4),which were lower than that of CS group(1.4±0.5,1.4±0.4,all P<0.05).At the same time,the time of regain consciousness was (9.2±1.2)min,which was also lower than CS group [(10.1±1.2)min,P<0.05].The recovery quality scores of the SP and CP group were (164±11) and (168±11) after 24 hours,which were greater than that of the SS and CS group(146±10,143±12,all P<0.05).Conclusion Dexmedetomidine combined with propofol in laparoscopic surgery can effectively suppress intraoperative stress,reduce postoperative pain and agitation,and improve the quality of postoperative recovery.