不同剂量右美托咪定对胃肠道恶性肿瘤根治术患者围术期电解质及术后康复的影响

Effects of different doses of dexmedetomidine on perioperative electrolytes and postoperative rehabi-litation in patients undergoing radical resection of gastrointestinal malignancy surgery

目的观察不同剂量右美托咪定对胃肠道恶性肿瘤根治术患者围术期电解质及术后康复的影响。方法选择择期全麻下胃肠道恶性肿瘤根治术患者106例,男40例,女66例,年龄55~75岁,BMI 18.5~25.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为四组:麻醉诱导前,D1组、D2组和D3组右美托咪定负荷剂量分别为1.0、1.0、0.5μg/kg(均于10 min内静脉泵注完成),维持剂量分别为0.25、0.5、0.5μg·kg^(-1)·h^(-1);C组生理盐水50 ml/h泵注10 min,维持量10 ml/h,四组维持剂量均至术毕前约30 min停止输注。于动脉穿刺完成后5 min(t_(0))、手术开始后1 h(t_(1))、术毕(t_(2))、入PACU后1 h(t_(3))、术后48 h(t_(4))测定血清K^(+)、Na^(+)、Ca^(2+)浓度,于t_(0)—t_(3)时测定血清乳酸浓度。记录丙泊酚及瑞芬太尼用量。记录术后48 h内腹腔引流量、镇痛泵总按压次数、镇痛泵有效按压次数、氟比洛芬酯追加例数。记录住院时间及术后肺部感染等并发症的发生情况。结果与t_(0)时比较,t_(4)时D1组、D2组和C组血清K^(+)浓度明显升高(P<0.05),t_(2)—t_(4)时D3组血清K^(+)浓度明显升高(P<0.05)。t_(4)时D2组血清K^(+)浓度明显低于C组(P<0.05);t_(2)时D3组血清K^(+)浓度明显高于D2组(P<0.05)。与t_(0)时比较,t_(4)时D1组、D2组和C组血清Na^(+)浓度明显降低(P<0.05)。t_(4)时D1组和D3组血清Na^(+)浓度明显高于C组(P<0.05)。与t_(0)时比较,t_(4)时D1组、D2组和C组血清Ca^(2+)浓度明显升高(P<0.05)。t_(3)、t_(4)时D3组血清Ca^(2+)浓度明显升高(P<0.05)。t_(3)时D3组血清Ca^(2+)浓度明显高于C组(P<0.05)。与t_(0)时比较,t_(1)时D2组和D3组血清乳酸浓度明显降低(P<0.05)。与C组比较,D2组丙泊酚用量明显减少(P<0.05),D1组、D2组和D3组瑞芬太尼用量明显减少(P<0.05)。四组术后48 h内腹腔引流量、镇痛泵总按压次数、镇痛泵有效按压次数、氟比洛芬酯追加率、住院时间和肺部感染率差异无统计学意义。结论右美托咪定的使用未降低胃肠道恶性肿瘤根治术患者围术期K^(+)浓度,负荷剂量0.5μg/kg、维持剂量0.5μg·kg^(-1)·h^(-1)可轻度升高入PACU后1 h血清K^(+)浓度,明显降低血清乳酸浓度,减少瑞芬太尼用量,且对术后康复无不利影响。

Objective To observe the effects of different doses of dexmedetomidine on perioper ative electrolytes and postoperative rehabilitation in patients undergoing radical resection of gastrointestinal malignant tumor surgery.Methods A total of 106 patients undergoing elective radical resection of gastrointestinal malignant tumor,40 males and 66 females,aged 55-75 years,BMI 18.5-25.0 kg/m^(2),ASA physical statusⅠ-Ⅲ,were randomly divided into 4 groups:groups D1,D2,and D3 received dexmedetomidine load dose 1.0,1.0 and 0.5μg/kg,and maintenance dose 0.25,0.5,and 0.5μg·kg^(-1)·h^(-1),respectively;group C received normal saline 50 ml/h for 10 minutes and maintenance dose 10 ml/h.Dexmedetomidine and normal saline maintenance doses were continuously given until approximately 30 minutes before the completion of surgery.Serum potassium,sodium,calcium,and lactic acid changes were recorded 5 minutes after arterial puncture(t_(0)),1 hour after surgery beginning(t_(1)),surgery ending(t_(2)),and 1 hour into the post-anesthesia care unit(PACU)(t_(3)).Serum potassium,sodium,and calcium were examined 48 hours after surgery(t_(4)).The dosage of propofol and remifentanil were recorded.Intraperitoneal drainage flow,total pressing times of analgesic pump,effective pressing times of analgesic pump,and additional cases of flurbiprofen were recorded within 48 hours after operation.The duration of hospitalization and the incidence of postoperative pulmonary infection were recorded.Results Compared with t_(0),serum potassium concentration in groups C,D1 and D2 were significantly increased at t_(4) and significantly increased at t_(2)-t_(4) in group D3(P<0.05).Serum potassium in group D2 was significantly lower than that in group C at t_(4)(P<0.05).Serum potassium in group D3 was significantly higher than that in group D2 at t_(2)(P<0.05).Compared with t_(0),serum sodium concentration in groups D1,D2 and C were significantly lower at t_(4)(P<0.05).Serum sodium concentration in groups D1 and D3 were significantly higher than those in group C at t_(4)(P<0.05).Compared with t_(0),serum calcium concentration was significantly increased in groups D1,D2 and C at t_(4) and significantly higher in group D3 at t_(3) and t_(4)(P<0.05).Serum calcium concentration was significantly increased in group D3 than that in group C at t_(3)(P<0.05).Compared with t_(0),serum lactate at t_(1) in groups D2 and D3 was significantly decreased.Compared with group C,the dosage of propofol was significantly decreased in group D2,and the dosage of remifentanil was significantly decreased in groups D1,D2 and D3(P<0.05).There were no significant differences in intraperitoneal drainage volume within 48 hours after operation,total pressing times of analgesic pump,effective pressing times of analgesic pump,addition rate of flurbiprofen axel,length of hospital stay and pulmonary infection rate among the four groups.Conclusion Dexmedetomidine dose not decrease perioperative potassium concentrations in patients undergoing radical resection of gastrointestinal malignancy,while its loading dose 0.5μg/kg and maintenance dose 0.5μg·kg^(-1)·h^(-1) elevates potassium slightly at 1 hour into the post-anesthesia care unit,reduces lactic acid and remifentanil dosage significantly,and has no adverse effect on postoperative rehabilitation.