丙泊酚或七氟烷联合右美托咪定应用于胃癌腹腔镜手术麻醉对患者的影响

Effect of propofol or sevoflurane combined with dexmedetomidine in laparoscopic surgery for gastric cancer

目的探讨丙泊酚或七氟烷联合右美托咪定对胃癌腹腔镜手术患者的影响。方法选取2018年1月至2019年11月于金华市中心医院行腹腔镜手术的胃癌患者80例,采用随机数字表法将其分为对照组和观察组,每组各40例。两组患者均采用右美托咪定、依托咪酯、舒芬太尼、顺式阿曲库铵进行麻醉诱导;对照组给予七氟烷进行麻醉维持,观察组给予丙泊酚进行麻醉维持,比较两组患者的苏醒质量、血流动力学各项指标及应激反应。结果术后观察组患者的意识恢复时间明显短于对照组(P<0.05);观察组患者的视觉模拟评分法(visual analogue scale,VAS)、躁动评分明显低于对照组(P<0.05);观察组患者的Ramsay镇静评分明显高于对照组(P<0.05)。无论是手术开始后30min(T1)还是拔管后10min(T2),两组患者的心率、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(oxygen saturation,SO_(2))水平与麻醉前(T0)时比较,差异无统计学意义(P>0.05)。T1、T2时两组患者的皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)水平较T0时均明显升高(P<0.05);且观察组患者的Cor、NE水平明显低于对照组(P<0.05)。观察组患者的不良反应发生率明显低于对照组(P<0.05)。结论丙泊酚联合右美托咪定麻醉可有效维持患者血流动力学稳定,减轻术中应激,提高苏醒质量,且具有良好的安全性。

Objective To investigate the effects of propofol or sevoflurane combined with dexmedetomidine in laparoscopic surgery for patients with gastric cancer.Methods A total of 80 patients with gastric cancer who underwent laparoscopic surgery in Jinhua Central Hospital from January 2018 to November 2019 were selected and divided into control group and observation group by random number table method,with 40 cases in each group.Dexmedetomidine,etomidate,sufentanil and cis-atracurium were used for anesthesia induction in both groups;Sevoflurane was used for anesthesia maintenance in control group,and propofol was used for anesthesia maintenance in observation group.The quality of recovery,hemodynamic indexes and stress response of the two groups were compared.Results The recovery time of consciousness in observation group was significantly shorter than control group(P<0.05).The visual analogue scale(VAS)and agitation score of observation group were significantly lower than those of control group(P<0.05);Ramsay sedation score in observation group was significantly higher than that in control group(P<0.05).No matter 30min after operation(T1),or 10min after extubation(T2),heart rate,mean arterial pressure(MAP),oxygen saturation(SO_(2))level was not significantly different from that before anesthesia(T0)(P>0.05).At T1 and T2,cortisol(Cor)and norepinephrine(NE)levels in both groups were significantly higher than those at T0(P<0.05);and NE and Cor levels in observation group were significantly lower than those in control group(P<0.05).The incidence of adverse reactions in observation group was significantly lower than that in control group(P<0.05).Conclusion Propofol combined with dexmedetomidine can effectively maintain hemodynamic stability,relieve intraoperative stress,improve the quality of recovery,and has good safety.