右美托咪定对胸腹腔镜联合IvorLewis食管切除术患者早期预后的影响

Effect of dexmedetomidine on the early recovery during early period after Ivor Lewis resection of esophageal carcinoma performed via video-assisted thoracoscope and laparoscope

目的评价右美托咪定对胸腹腔镜联合IvorLewis食管切除术患者早期预后的影响。方法选取择期行胸腹腔镜联合IvorLewis食管切除术患者80例,年龄45~79岁,体质指数为19~27 kg/m^2,ASA分级Ⅱ至Ⅲ级。采用随机数字表法,将其分为两组:右美托咪定组(D组,n=40)和对照组(C组,n=40)。麻醉诱导前D组经10 min静脉输注负荷剂量右美托咪定0.5μg/kg,然后以0.5μg·kg-1·h-1的速率静脉输注至手术结束前40 min;C组给予等容量0.9%氯化钠注射溶液。分别于术前24 h、术后72 h时采用QoR-40量表对患者进行分项评估。记录两组患者术后恢复情况(首次肛门排气时间、尿管留置时间、胃管留置时间和住院时间)。结果与C组比较,D组术后72 h身体舒适度更佳,同时情绪更乐观(P<0.05);有更好的自理能力(P<0.001);总评分更高(P<0.001)。与C组比较,D组患者术后肛门排气时间、尿管留置时间、胃管留置时间均明显缩短(P<0.05)。结论右美托咪定可改善胸腹腔镜联合IvorLewis食管切除术患者的早期预后。

Objective To evaluate the effect of dexmedetomidine on the early recovery after IvorLewis resection of esophageal carcinoma performed via video-assisted thoracoscope and laparoscope.Methods Eighty patients who scheduled for elective IvorLewis resection of esophageal carcinoma performed via video-assisted thoracoscope and laparoscope,including males or females,aged 45 to 79 years,were selected for the study,whose body mass index(BMI)ranges from 19 to 27 kg/m^2 and American Society of Anesthesiologists physical status ranges fromⅡtoⅢ.The patients were randomly divided into either dexmedetomidine group(group D,n=40)or control group(group C,n=40)using a random number table.In group D,dexmedetomidine was intravenously infused in a loading dose of 0.5μg/kg for 10 min before anesthesia induction,followed by an infusion of 0.5μg·kg-1·h-1 until 40 min before the end of surgery,while the equal volume of 0.9%normal saline was given instead of dexmedetomidine in group C.The global QoR-40 aggregate scores of patients were recorded 24 hours before surgery and 72 hours after surgery.Postoperative recovery of patients in the two groups was recorded(the time of first flatus,urocatheter tube removal,nasogastric tube removal after surgery,and duration of hospital stay).Results Compared with group C,group D produced better physical comfortableness with more positiveness(P<0.05),better self-care ability(P<0.001)and higher total score(P<0.001).Compared with group C,the time of flatus,urocatheter tube removal and nasogastric tube removal after surgery were shorter in group D(P<0.05).Conclusion Dexmedetomidine can improve the quality of early recovery after IvorLewis resection of esophageal carcinoma performed via video-assisted thoracoscope and laparoscope.