右美托咪定联合布托啡诺用于腹腔镜结直肠癌根治术的临床观察

Clinical Observation of Dexmedetomidine Combined with Butorphanol for Laparoscopic Radical Resection of Colorectal Cancer

目的:观察右美托咪定联合布托啡诺用于腹腔镜结直肠癌根治术的麻醉效果及安全性。方法:选择2019年4月-2020年5月我院拟行腹腔镜结直肠癌根治术的患者180例,按随机数字表法分为对照组(C组)、右美托咪定组(D组)、布托啡诺组(B组)和右美托咪定+布托啡诺组(E组),每组各45例。C组患者行依托咪酯乳状注射液+枸橼酸舒芬太尼注射液+注射用苯磺顺阿曲库铵常规麻醉诱导;D组患者于诱导前15 min静脉泵注盐酸右美托咪定注射液0.5μg/kg,并行C组常规麻醉诱导;B组患者麻醉诱导时静脉推注酒石酸布托啡诺注射液0.02 mg/kg,并行C组常规麻醉诱导;E组患者麻醉诱导同D组+B组。观察各组患者舒芬太尼用量和七氟烷术中维持浓度,入室时(T0)、插管后1 min(T1)、切皮后1 min(T2)、拔管后5 min(T3)时的平均动脉压(MAP)、心率(HR)以及拔管时间和拔管后5 min的Ramsay镇静评分、疼痛视觉模拟(VAS)评分,并记录不良反应发生情况。结果:C组有1例、E组有2例患者因手术方式由腹腔镜转为开放手术而被剔除,其余患者均完成本研究。T1~T3时,C、D和B组患者MAP、HR均显著高于同组T0时(P<0.05),而E组患者T1~T3时MAP、HR与T0比较差异均无统计学意义(P>0.05)。T1~T2时D、B组患者和T1~T3时E组患者MAP均显著低于C组,且E组<B组<D组(除T3时B、D组间比较外);T1~T3时D、E组患者和T1~T2时B组患者HR均显著低于C组,且E组<B组<D组(除T3时B、D组间比较外)(P<0.05)。B、D、E组患者舒芬太尼用量、VAS评分均显著低于C组,且舒芬太尼用量为E组<B组<D组,VAS评分为E组<B、D组(P<0.05),E组患者七氟烷术中维持浓度、拔管时间、恶心呕吐、苏醒期躁动发生率均显著低于或短于C、D、B组,Ramsay镇静评分均显著高于C、D、B组,且恶心呕吐、苏醒期躁动发生率均为E组<D、B组(P<0.05),但C、D和B组七氟烷术中维持浓度、Ramsay镇静评分、拔管时间比较,D、B组VAS评分、恶心呕吐、苏醒期躁动发生率比较,差异均无统计学意义(P>0.05)。结论:右美托咪定联合布托啡诺能有效减少腹腔镜结直肠癌根治术患者的术中麻醉药物用量和应激反应的发生,提高苏醒质量,降低术后不良反应的发生率。

OBJECTIVE:To observe the anesthetic effect and safety of dexmedetomidine combined with butorphanol for laparoscopic radical resection of colorectal cancer.METHODS:Totally 180 patients undergoing elective laparoscopic radical resection of colorectal cancer were selected from our hospital during Apr.2019-May 2020.They were randomly divided into control group(group C),dexmedetomidine group(group D),butorphanol group(group B),dexmedetomidine+butorphanol group(group E),with 45 cases in each group.Group C received rountine anesthesia of Etomidate emulsion injection+Sufentanil citrate injection+Cisatracurium besylate for injection.Group D was given Dexmedetomidine injection 0.5μg/kg by pumping 15 min before induction,and received rountine anesthesia indution performed in group C.Group B was given intravenous injection of Butorphanol tartrate injection 0.02 mg/kg when anesthesia indution,and received rountine anesthesia performed in group C.Anesthesia induction in group E was the same as that in group D+B.The dosage of sufentanil and the maintenance concentration of sevoflurane were observed;average arterial pressure(MAP)and heart rate(HR)at the time of entering the room(T0),1 min after intubation(T1),1 min after skin incision(T2),and 5 min after extubation(T3),extubation time,Ramsay sedation score 5 min after extubation and VAS score,the occurrence of ADR were recorded.RESULTS:One patient in group C and two patients in Group E were excluded due to the conversion of laparoscopic surgery to open surgery.The rest of the patients completed the study.At T1-T3,MAP and HR in group C,D and B were significantly higher than those at T0(P<0.05),while there was no significant difference in MAP or HR in group E at T1-T3,compared with those at T0(P>0.05).MAP of group D and B at T1-T2 as well as MAP of group E at T1-T3 were significantly lower than that of group C,the order was group E<group B<Group D(except for group B compared with group D at T3);HR of group D and E at T1-T3 as well as that of group B at T1-T2 were significantly lower than group C,and the order was group E<group B<Group D(except for group B compared with group D at T3)(P<0.05).The amount of sufentanil and VAS score of group B,D,E were significantly lower than that of group C,and the order was group E<group B<group D,VAS score of group E<group D,B(P<0.05).The maintenance concentration,extubation time,nausea and vomiting,the incidence of agitation during recovery period in group E were significantly lower or shorter than group C,D,B.Ramsay sedation score was significantly higer than group C,D and B.The nausea and vomiting,the incidence of emergence agitation in group E<group D,B(P<0.05).There was no statistical significance in the maintenance concentration of sevoflurane,Ramsay sedation score or extubation time among group C,D and B,VAS score,the incidence of nausea and vomiting,the incidence of agitation during recovery period between group D and B(P>0.05).CONCLUSIONS:Dexmedetomidine combined with butorphanol can effectively reduce the amount of intraoperative anesthetics and the occurrence of stress reaction,improve the quality of resuscitation,and reduce the incidence of postoperative ADR.