七氟烷联合右美托咪定对结肠肿瘤术中麻醉效果、血流动力学及脑氧代谢的影响

Effects of Sevoflurane Combined with Dexmedetomidine on Intraoperative Anesthesia, Hemodynamics, andCerebral Oxygen Metabolism in Colon Tumor Surgery

目的 探讨七氟烷或丙泊酚联合右美托咪定对结肠肿瘤术中麻醉、血流动力学、脑氧代谢及术后麻醉苏醒的影响。方法 选取2020年1月—2021年10月收治的行全麻手术的结肠肿瘤96例,按麻醉药物分为七氟烷组和丙泊酚组,各48例。2组采用相同麻醉诱导方法,七氟烷组采用七氟烷联合右美托咪定维持麻醉,丙泊酚组采用丙泊酚联合右美托咪定维持麻醉。比较2组切皮时、切皮后10 min、切皮后30 min、术毕时镇静Ramsay评分,麻醉诱导前(T1)、麻醉诱导后(T2)、气管插管时(T3)、切皮时(T4)、拔管时(T5)血流动力学、脑氧代谢、麻醉苏醒情况,统计2组不良反应发生情况。结果 2组切皮时、切皮后10 min、切皮后30 min、术毕时镇静Ramsay评分比较差异无统计学意义(P>0.05)。2组T1、T2、T3、T4、T5时点心率、平均动脉压比较差异无统计学意义(P>0.05)。2组T2、T3、T4时点脑氧代谢率(CERO_(2))、脑动静脉血氧含量差(Da-jvO_(2))、脑组织氧饱和度(ScO_(2))均较T1时点降低,颈静脉血氧饱和度(SjvO_(2))均较T1时点升高(P<0.05);七氟烷组T2、T3、T4时点CERO_(2)、Da-jvO_(2)低于丙泊酚组,SjvO_(2)、ScO_(2)高于丙泊酚组(P<0.05,P<0.01)。七氟烷组自主呼吸恢复、拔管、呼之睁眼与定向力恢复时间短于丙泊酚组(P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 七氟烷或丙泊酚联合右美托咪定应用于结肠肿瘤术中麻醉可取得相似的镇静镇痛效果,均能维持血流动力学的稳定,但七氟烷联合右美托咪定能减小对脑氧代谢的影响,加快患者术后麻醉苏醒。

Objective To investigate the effects of Sevoflurane or Propofol combined with Dexmedetomidine on intraoperative anesthesia,hemodynamics,cerebral oxygen metabolism and postoperative anesthesia resuscitation in colon tumor surgery.Methods A total of 96 patients with colon tumor who received surgery under general anesthesia from January 2020 to October 2021 were selected and divided into Sevoflurane group(n=48)and Propofol group(n=48)according to anesthetic drugs.The two groups were given the same anesthesia induction method.Sevoflurane group received Sevoflurane+Dexmedetomidine to maintain anesthesia,while Propofol group received Propofol+Dexmedetomidine to maintain anesthesia.Ramsay score of sedation during dermectomy,at 10 min after dermectomy,at 30 min after dermectomy and at the end of surgery,and the hemodynamics,cerebral oxygen metabolism and anesthesia resuscitation of the two groups before anesthesia induction(T1),after anesthesia induction(T2),during tracheal intubation(T3),during dermectomy(T4),and during extubation(T5)were compared.The occurrence of adverse reactions in the two groups was calculated.Results There was no significant difference in Ramsay score of sedation between the two groups during dermectomy,at 10 min after dermectomy,and at 30 min after dermectomy(P>0.05).There were no significant differences in heart rate and mean arterial pressure at T1,T2,T3,T4 and T5 between the two groups(P>0.05).Cerebral metabolic rate of oxygen(CERO_(2)),cerebral arterio-venous oxygen content difference(Da-jvO_(2))and cerebral tissue oxygen saturation(SctO_(2))at T2,T3 and T4 were all decreased compared with those at T1,while jugular vein blood oxygen saturation(SjvO_(2))was increased compared with that at T1(P<0.05).CERO_(2) and Da-jvO_(2) at T2,T3 and T4 in Sevoflurane group were lower than those in Propofol group,while SjvO_(2) and ScO_(2) were higher than those in Propofol group(P<0.05,P<0.01).The recovery time of spontaneous respiration,extubation,eye opening and orientation in Sevoflurane group was shorter than that in Propofol group(P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Sevoflurane or Propofol combined with Dexmedetomidine can achieve similar sedative and analgesic effects during colon tumor surgery,and both can maintain hemodynamic stability.However,Sevoflurane combined with Dexmedetomidine can reduce the impact on cerebral oxygen metabolism and accelerate the recovery of patients from anesthesia after surgery.