腹腔镜胃癌D2根治术中右美托咪定麻醉效果及对术后血流动力学、疼痛视觉模拟评分及Ramsay镇静评分的影响

Anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics,visual analogue scale and Ramsay sedation score after operation

目的探讨右美托咪定在腹腔镜胃癌D2根治术中的麻醉效果及对患者术后血流动力学、疼痛视觉模拟评分(VAS)、Ramsay镇静评分的影响。方法选择2017年3月至6月山西省肿瘤医院在全身静脉麻醉下行胃癌D2根治术患者86例,应用随机数字表法分为对照组和观察组,每组43例。观察组在全身静脉麻醉诱导前静脉泵注0.6μg/kg右美托咪定,15 min后剂量改为0.4μg/kg,于手术结束前30 min停用;对照组给予等量0.9%氯化钠注射液。比较两组麻醉诱导前(T1)、气管插管时(T2)、插管后(T3)、切片时(T4)、拔管后即刻(T5)的平均动脉压(MAP)及心率变化,术后1 h及4 h的VAS和Ramsay镇静评分,术中麻醉维持药物的用量。结果观察组T1、T3~T5时的心率、MAP均低于对照组,差异均有统计学意义(均P<0.05)。观察组术后1、4 h的VAS、Ramsay评分均优于对照组,差异均有统计学意义(均P<0.05)。观察组术中丙泊酚、瑞芬太尼用量分别为(964±251)mg、(3.1±0.8)mg,均少于对照组[(1485±425)mg、(4.8±0.8)mg],差异均有统计学意义(t=9.913,P<0.01;t=9.834,P<0.01)。结论右美托咪定在腹腔镜胃癌D2根治术麻醉中可减少患者的应激反应,增强镇静镇痛效果,减少丙泊酚和瑞芬太尼的使用量,临床应用价值较高。

Objective To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics,visual analogue scale(VAS)and Ramsay sedation score after operation.Methods A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled,and all the patients were divided into two groups by using random number table method.The observation group(43 cases)was intravenously injected with dexmedetomidine(0.6μg/kg)before induction of general anesthesia,and the dose was changed to 0.4μg/kg after 15 min with drug withdrawal till 30 minutes before surgery,the control group(43 cases)was given an equal volume of 0.9%normal saline.The mean arterial pressure(MAP)and heart rate change before anesthetic induction(T1),tracheal intubation time(T2),after intubation(T3),section time(T4)and the immediate time after intubation(T5)were compared between the two groups.The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups.Results The heart rate and MAP of the observation group were lower than those of the control group at the time of T1,T3-T5,the differences were statistically significant(all P<0.05).The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation,and the differences were statistically significant(all P<0.05).The intraoperative doses of propofol and remifentanil in the observation group were(964±251)mg and(3.1±0.8)mg,respectively,which were less than those in the control group[(1485±425)mg and(4.8±0.8)mg],the differences were statistically significant(t=9.913,P<0.01;t=9.834,P<0.01).Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia,enhance the sedative effect,and reduce the dosage of propofol and remifentanil,therefore,it has high clinical application value.