丙泊酚与七氟烷复合右美托咪定麻醉对肝切除术患者的影响

Effects of propofol and sevoflurane combined with dexmedetomidine anesthesia on patients undergoing hepatectomy

目的分析丙泊酚与七氟烷分别复合右美托咪定麻醉对肝切除术患者的影响。方法前瞻性分析2020年1月至2022年3月期间在单县中心医院拟行腹腔镜肝切除术患者120例,按照随机数字表法分为甲组和乙组,各60例。甲组患者男37例,女23例,年龄(52.45±8.76)岁,采用丙泊酚复合右美托咪定麻醉;乙组患者男35例,女25例,年龄(52.64±8.23)岁,采用七氟烷复合右美托咪定麻醉。比较两组患者的心率(HR)、平均动脉压(MAP)、手术时间、自主呼吸恢复时间、睁眼时间、拔管时间,评价两组恢复质量,检测两组肝功能指标,分析两组并发症发生情况。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果甲组和乙组患者插管时HR[(89.78±5.25)次/min和(85.96±4.52)次/min]、切皮时HR[(93.75±4.53)次/min和(87.88±4.42)次/min]、术毕HR[(86.58±5.01)次/min和(84.68±3.85)次/min],均比麻醉前[(82.70±3.62)次/min和(87.98±6.59)次/min]明显升高(均P<0.05);甲组和乙组患者插管时MAP[(93.55±5.36)mmHg(1 mmHg=0.133 kPa)和(89.13±4.70)mmHg]、切皮时MAP[(103.42±5.26)mmHg和(91.67±5.93)mmHg]、术毕MAP[(95.96±5.59)mmHg和(92.93±4.89)mmHg],均较麻醉前[(87.98±6.59)mmHg和(87.67±5.82)mmHg]明显升高(均P<0.05);且乙组均明显低于甲组(均P<0.05)。乙组的自主呼吸恢复时间、睁眼时间及拔管时间均明显短于甲组[(10.03±1.73)min比(13.36±2.06)min、(11.05±1.70)min比(14.42±2.08)min、(12.10±1.70)min比(15.39±2.06)min],差异均有统计学意义(t=9.59、9.72、9.54,均P<0.01);而两组的手术时间比较差异无统计学意义(t=1.56,P=0.12)。乙组的呛咳评分、Biker镇静-躁动评分均明显低于甲组[(1.99±0.36)分比(2.56±0.26)分、(2.10±0.41)分比(3.17±0.35)分],乙组Ramsay镇静评分明显高于甲组[(3.38±0.48)分比(2.45±0.32)分],差异均有统计学意义(t=9.94、15.37、12.49,均P<0.01)。术后3 d,乙组的血清丙氨酶转氨酶、天冬氨酸转氨酶、总胆红素水平均明显低于甲组[(69.70±22.00)U/L比(95.35±25.51)U/L、(52.26±18.22)U/L比(70.18±15.30)U/L、(22.19±2.14)μmol/L比(25.86±2.50)μmol/L],白蛋白水平高于甲组[(35.44±4.46)g/L比(29.98±5.63)g/L],差异均有统计学意义(t=5.90、5.83、8.64、5.89,均P<0.01)。乙组的并发症总发生率稍低于甲组[10.00%(6/60)比13.33%(8/60)],但差异无统计学意义(χ^(2)=0.32,P=0.57)。结论七氟烷复合右美托咪定麻醉可有效改善腹腔镜肝切除术患者的肝功能及麻醉苏醒质量,并维持血流动力学稳定,且并发症较少,具有一定的临床应用价值。

Objective To analyze the effects of propofol and sevoflurane combined with dexmedetomidine on patients undergoing hepatectomy.Methods A prospective analysis was conducted on 120 patients who were scheduled to undergo laparoscopic hepatectomy in Shanxian Central Hospital from January 2020 to March 2022,and they were divided into group A and group B according to the random number table method,60 cases in each group.There were 37 males and 23 females in group A,with an age of(52.45±8.76)years old.There were 35 males and 25 females in group B,with an age of(52.64±8.23)years old.Group A was given propofol combined with dexmedetomidine anesthesia,and group B was given sevoflurane combined with dexmedetomidine anesthesia.The heart rate(HR),mean arterial pressure(MAP),operation time,spontaneous breathing recovery time,eye opening time,and extubation time were compared between the two groups,the recovery quality was evaluated,the liver function indexes were detected,and the complications of the two groups were analyzed.Independent sample t test,paired t test,andχ^(2) test were used for statistical analysis.Results The HR in group A and group B were(89.78±5.25)beats/min and(85.96±4.52)beats/min at intubation,(93.75±4.53)beats/min and(87.88±4.42)beats/min at skin cutting,and(86.58±5.01)beats/min and(84.68±3.85)beats/min at the end of surgery,which were significantly higher than those before anesthesia[(82.70±3.62)beats/min and(87.98±6.59)beats/min](all P<0.05);the MAP in group A and group B were(93.55±5.36)mmHg(1 mmHg=0.133 kPa)and(89.13±4.70)mmHg at intubation,(103.42±5.26)mmHg and(91.67±5.93)mmHg at skin cutting,(95.96±5.59)mmHg and(92.93±4.89)mmHg at the end of surgery,which were significantly higher than those before anesthesia[(87.98±6.59)mmHg and(87.67±5.82)mmHg](all P<0.05);those in group B were significantly lower than those in group A(all P<0.05).The spontaneous breathing recovery time,eye opening time,and extubation time of group B were significantly shorter than those of group A[(10.03±1.73)min vs.(13.36±2.06)min,(11.05±1.70)min vs.(14.42±2.08)min,(12.10±1.70)min vs.(15.39±2.06)min],with statistically significant differences(t=9.59,9.72,and 9.54;all P<0.01);there was no statistically significant difference in the operation time between the two groups(t=1.56,P=0.12).The cough score and Biker sedation-agitation score of group B were significantly lower than those of group A[(1.99±0.36)vs.(2.56±0.26),(2.10±0.41)vs.(3.17±0.35)],and the Ramsay sedation score in group B was significantly higher than that in group A[(3.38±0.48)vs.(2.45±0.32)],with statistically significant differences(t=9.94,15.37,and 12.49;all P<0.05).On the third day after surgery,the serum levels of alanine aminotransferase,aspartate aminotransferase,and total bilirubin in group Bwere significantly lower than those in group A[(69.70±22.00)U/L vs.(95.35±25.51)U/L,(52.26±18.22)U/L vs.(70.18±15.30)U/L,(22.19±2.14)μmol/L vs.(25.86±2.50)μmol/L],and the serum albumin level was higher than that in group A[(35.44±4.46)g/L vs.(29.98±5.63)g/L],with statistically significant differences(t=5.90,5.83,8.64,and 5.89;all P<0.01).The total incidence of complications in group B was slightly lower than that in group A[10.00%(6/60)vs.13.33%(8/60)],but the difference was not statistically significant(χ^(2)=0.32,P=0.57).Conclusion Sevoflurane combined with dexmedetomidine anesthesia can effectively improve the liver function and quality of anesthesia recovery in patients undergoing laparoscopic hepatectomy,and maintain stable hemodynamics with fewer complications,which has a certain clinical application value.