不同药物麻醉对胃癌根治术患者的麻醉效果及术后凝血功能的影响研究

Study on the anesthetic effect of different drug anesthesia on patients undergoing radical gastrectomy and effect of postoperative coagulation function

目的探讨不同药物麻醉对胃癌根治术患者的麻醉效果及术后凝血功能的影响。方法选择我院2016年4月~2018年4月收治的124例患者随机分为观察组(n=62)和对照组(n=62)。观察组给予0.5 μg/kg右美托咪定麻醉,对照组于同期给予等量生理盐水。观察比较两组手术时间、术中输液量、麻醉药(丙泊酚、舒芬太尼)的剂量、住院时间及术后不良反应情况;麻醉诱导前和术后3 h凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、血浆纤维蛋白原及D-二聚体。结果术后,观察组手术时间、术中输液量与对照组比较,差异无统计学意义(P>0.05);住院时间、丙泊酚、舒芬太尼剂量明显低于对照组(P<0.05)。观察组各凝血指标与术前比较得到改善(P<0.05),对照组各凝血功能指标与术前比较差异无统计学意义(P>0.05),且观察组术后各指标均优于对照组(P<0.05)。观察组患者出现发热、感染等不良反应共7例(11.29%),明显低于对照组的14例(22.58%)(χ2=4.324,P=0.038)。结论右美托咪定在胃癌根治术中麻醉效果显著,可有效减轻机体应激反应,对凝血功能影响小,安全性高,值得推广应用。

Objective To investigate the anesthetic effects of different drug anesthesia in the patients undergoing radical gastrectomy and the effect on postoperative coagulation function. Methods A total of 124 patients who were admitted to our hospital from April 2016 to April 2018 were selected and randomly divided into observation group(n=62) and control group(n=62). The observation group was given anesthesia with 0.5 μg/kg dexmedetomidine. The control group was given the same amount of normal saline at the same time. The operation time, the intraoperative fluid volume, the dose of anesthetic(propofol, sufentanil), length of stay and postoperative adverse reactions were observed and compared. Prothrombin time, activated partial thromboplastin time, plasma thrombin time, plasma fibrinogen and D-dimer before induction of anesthesia and 3 hours after surgery were observed and compared. Results After operation, there was no statistically significant difference in the operation time and intraoperative fluid volume between the observation group and the control group(P>0.05);the length of stay, propofol and sufentanil doses were significantly lower than those in the control group(P<0.05). The coagulation parameters in the observation group were improved compared with those before operation(P<0.05). There was no statistically significant difference in the coagulation function indices in the control group compared with that before operation(P>0.05), and the indicators in the observation group were better than that in the control group after operation(P<0.05). There were 7 cases(11.29%) of adverse reactions such as fever and infection in the observation group, which was significantly lower than 14 cases(22.58%) in the control group(χ2=4.324, P=0.038). Conclusion Dexmedetomidine has a significant anesthetic effect in radical gastrectomy, which can effectively alleviate the body's stress response, has little effect on coagulation function, and has high safety. It is worthy of popularization and application.