右美托咪定负荷量对腹腔镜结直肠切除术患者肠功能恢复的影响

Effects of dexmedetomidine loading dose on intestinal function recovery in patients after laparoscopic colorectal resection

目的探讨负荷剂量右美托咪定(dexmedetomidine,Dex)的使用对结直肠切除术后肠功能恢复的影响。方法回顾性分析西安交通大学第一附属医院2017年10月至2018年8月收治的259例行腹腔镜结直肠切除术患者的临床资料,根据术中是否输注负荷剂量(1μg/kg)Dex分为两组:负荷量组(负荷剂量Dex 1μg/kg,输注10 min;维持剂量0.4μg·kg^-1·h^-1),119例;维持量组(维持剂量0.4μg·kg^-1·h^-1输注),140例。记录患者一般人口学特征、肿瘤特点、麻醉手术相关信息等,并分别于输注Dex前(T0)、输注Dex 10 min后(T1)、Dex停用时(T2)、手术结束时(T3)记录SBP、DBP、MAP、心率及PETCO2。比较两组患者术后排气、排便时间,恶心、呕吐发生率,以及住院时间。结果负荷量组高血压患者比例高于维持量组(P<0.05),术中Dex用量及血管活性药物(阿托品、乌拉地尔、麻黄碱)用量明显高于维持量组(P<0.05),瑞芬太尼用量低于维持量组(P<0.05),T1时心率慢于维持量组,T2时DBP及MAP低于维持量组(P<0.05),术后排气时间短于维持量组(P<0.05)。结论腹腔镜结直肠切除术中使用负荷剂量Dex可以促进患者肠功能的早期恢复,缩短患者术后排气时间。

Objective To investigate the effects of dexmedetomidine(Dex)loading dose on intestinal function recovery in patient after colorectal resection.Methods A total of 259 patients who were admitted into the First Affiliated Hospital of Xi'an Jiaotong University from October 2017 to August 2018 and underwent laparoscopic colorectal resection were enrolled and their clinical data was retrospectively analyzed.They were divided into two groups according to whether a load dose(1μg/kg)of Dex was pumped during the operation:a loading dose group(n=119,loading dose:1μg/kg,infusion over 10 min,maintenance dose:0.4μg·kg^-1·h^-1)and a maintenance dose group(n=140,maintenance dose:0.4μg·kg^-1·h^-1 through pump injection).The general demographic characteristics of patients and information related to anesthesia operation were recorded.Furthermore,systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP),heart rate and end-tidal carbon dioxide(PETCO2)were recorded before Dex infusion(T0),10 min after Dex infusion(T1),when Dex was stopped(T2)and at the end of operation(T3).Both groups were compared for exhaust and defecation time,the incidence of nausea and vomiting,and hospitalization length.Results Compared with the maintenance dose group,the loading dose group presented an increased percentage of hypertension patients(P<0.05),and required remarkably increased doses of Dex and vascular active agents(atropine,urapidil,and ephedrine)(P<0.05)as well as decreased doses of remifentanil(P<0.05).Furthermore,the loading dose group produced slower heart rate at T1,lower DBP and MAP(P<0.05)and shorter exhaust time(P<0.05)than the maintenance dose group.Conclusions Dex loading dose can promote fast recovery of intestinal function and shorten exhaust time laparoscopic colorectal resection.