老年腹腔镜下肿瘤切除术患者七氟醚和瑞芬太尼联合右美托咪定麻醉对血流动力学影响

Hemodynamic effect of sevoflurane and remifentanil combined with dexmedetomidine anesthesia in elderly patients undergoing laparoscopic tumor resection

目的腹腔镜下切除术近年来广泛用于肿瘤患者治疗,但患者在术前麻醉诱导期易引发并发症。不同的麻醉药物对患者血流动力学影响程度亦不同,因此麻醉药物的配伍方法对患者麻醉过程中血流动力学以及早期认知功能存在重要影响。本研究探讨右美托咪定对老年腹腔镜下胃癌根治术患者血流动力学与心肌损伤影响。方法选择2017-07-01-2018-06-25西华县人民医院行腹腔镜胃癌根治术的老年患者作为研究对象,按照两组间性别、年龄及体质量指数(body mass index,BMI)均衡的原则选择观察组和对照组各49例。诱导前观察组给予1μg/kg右美托咪定泵注麻醉,对照组给予等量生理盐水泵注;麻醉诱导后两组均给予丙泊酚、瑞芬太尼泵注以及顺-阿曲库铵间断静脉注射;同时术中观察组给予右美托咪定0.5μg/(kg·h)泵注,对照组给予等量生理盐水泵注。观察两组患者心率(heart rate,HR)、舒张压(diastolic blood pressure,DBP)、收缩压(systolic blood pressure,SBP)以及不良反应。结果T1时观察组DBP水平为(81.54±5.90)mm Hg,高于对照组的(72.93±8.54)mm Hg,t=5.806,P<0.001;SBP水平为(132.54±11.25)mm Hg,高于对照组的(113.98±14.76)mm Hg,t=7.001,P<0.001;肌钙蛋白I(troponin I,cTnl)水平为(1.23±0.09)ng/mL,低于对照组的(1.74±0.08)ng/mL,t=29.647,P<0.001;心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)水平为(0.58±0.07)μg/mL,低于对照组的(0.83±0.06)μg/mL,t=18.981,P<0.001;肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)水平为(25.33±3.76)U/mL,低于对照组的(29.48±3.46)U/mL,t=5.685,P<0.001。两组不良反应发生率相比,差异无统计学意义,χ^2=0.615,P=0.239。结论腹腔镜胃癌根治术患者术中运用右美托咪定有利于患者血流动力学的稳定,对患者心肌具有保护作用,用药安全性较高。

OBJECTIVE Laparoscopic resection has been widely used in the treatment of cancer patients in recent years,but patients are prone to complications during the induction period of preoperative anesthesia.Different anesthetics have different effects on hemodynamics,so the compatibility of anesthetics has important effects on hemodynamics and early cognitive function of patients during anesthesia.This study aims to investigate the effect of dexmedetomidine on hemodynamics and myocardial injury in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer.METHODS The elderly patients who underwent laparoscopic radical gastrectomy in Xihua County People′s Hospital from July 1,2017 to June 25,2018 were selected as the study subjects.According to the principle of gender,age and body mass index(BMI)balance between the two groups,49 cases in the observation group and 49 cases in the control group were selected.Before the induction,the observation group was given anesthesia with 1μg/kg dexmedetomidine pump,and the control group was given the same amount of saline pumping;after anesthesia induction,both groups were given propofol,remifentanil pump and cis-Aqu Sucuronium was injected intermittently;the intraoperative observation group was given dexmedetomidine 0.5μg/(kg·h)pumping,and the control group was given the same amount of saline pumping.The heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP)and adverse reactions were observed in the two groups.RESULTS The DBP level of the observation group at T1 was(81.54±5.90)mmHg,which was higher than that of the control group(72.93±8.54)mmHg,t=5.806,P<0.001;the SBP level was(132.54±11.25)mmHg,which was higher than that of the control group(113.98±14.76)mmHg,t=7.001,P<0.001;troponin I(cTnl)level was(1.23±0.09)ng/ml,which was lower than that of the control group(1.74±0.08)ng/ml,t=29.647,P<0.001;the level of heart-type fatty acid binding protein(H-FABP)was(0.58±0.07)μg/ml,which was lower than that of the control group(0.83±0.06)μg/ml,t=18.981,P<0.001;the level of creatine kinase isoenzyme(CK-MB)was(25.33±3.76)U/ml,which was lower than that of the control group(29.48±3.46)U/ml,t=5.685,P<0.001.There was no significant difference in the incidence of adverse reactions between the two groups,χ^2= 0.615,P = 0.239.CONCLUSION The use of dexmedetomidine in patients undergoing laparoscopic radical gastrectomy is beneficial to the stability of hemodynamics and has a protective effect on the patient′s myocardium.