右美托咪定负荷剂量不同给药途径对腹腔镜结肠癌根治术患者苏醒期应激反应的影响

Effect of Different Routes of Dexmedetomidine Administration on Stress Response During Recovery Period from General Anesthesia in Patients Underwent Laparoscopic Radical Resection of Colon Cancer

目的 探讨手术结束前20 min不同途径给予右美托咪定1μg/kg负荷剂量对腹腔镜结肠癌根治术患者苏醒期应激反应的影响。方法 将90例结肠癌根治术患者随机分为DI组、DN组和NS组,每组30例。DI组手术结束前20 min给予1μg/kg右美托咪定静脉泵注10 min,浓度为4μg/ml;DN组手术结束前20 min给予1μg/kg右美托咪定滴鼻,体积为1 ml;NS组不予处理。比较患者用药时(T0)、术毕时(T1)、拔管时(T2)、拔管后30 min(T3)MAP、HR、NE、AngⅡ、Glu浓度,麻醉苏醒指标及不良反应发生情况。结果 3组T0时MAP、HR、NE、AngⅡ、Glu浓度差异无统计学意义(P>0.05);T2、T3时DI和DN组MAP、HR、NE、AngⅡ、Glu浓度明显低于NS组(P<0.05);T1时DI组上述指标明显低于DN组(P<0.05)。NS组和DN组呼之能应时间、拔管时间、定向力恢复时间明显短于DI组(P<0.05);3组自主呼吸恢复时间、PACU观察时间差异无统计学意义(P>0.05)。DI组和DN组呛咳、高血压、心动过速发生率明显低于NS组(P<0.05),DN组低血压、心动过缓发生率明显低于DI组(P<0.05)。结论 腹腔镜结肠癌根治术患者手术结束前20 min予右美托咪定1μg/kg负荷剂量能有效降低苏醒期应激反应,减少不良反应的发生,滴鼻操作更加简单安全,且能显著降低苏醒期低血压及心动过缓的发生率,值得临床进一步推广。

Objective To evaluate the effects of 1μg/kg dexmedetomidine with different administration routes at 20 min prior to the end of surgery on the stress response of patients undergoing laparoscopic radical resection of colon cancer during recovery period from general anesthesia.Methods 90 patients underwent laparoscopic radical resection of colon cancer were randomly divided into DI,DN and NS groups,with 30 patients in each group.At 20 minutes prior to the end of surgery,in the DI group,1μg/kg of dexmedetomidine was administered intravenously for 10 min at a concentration of 4μg/ml.Dexmedetomidine 1μg/kg was given as a nasal drop in a volume of 1ml at 20 minutes before the end of the operation in group DN.NS group will not be processed.Comparison of MAP,HR,NE,AngⅡ,Glu concentration,anesthesia awakening index and adverse reactions at the time of drug administration(T0),immediately after operation(T1),immediately after extubation(T2)and 30 min after extubation(T3).Results There was no statistically significant difference in MAP,HR,NE,AngⅡ,Glu concentration at T0 among the three groups(P>0.05);MAP,HR,NE,Ang II,and Glu concentrations were significantly lower in the DI and DN groups than in the NS group at T2 and T3.The above indexes were significantly lower in the DI group than in the DN group at T1.NS and DN groups'response time,extubation time and orientation recovery time were significantly shorter than those of DI group(P<0.05);the differences in recovery time of spontaneous breathing and PACU observation time of the 3 groups were not statistically significant(P>0.05).The incidence of choking,hypertension,and tachycardia was significantly lower in the DI and DN groups than in the NS group(P<0.05),and the occurrence of hypotension and bradycardia was significantly lower in the DN group than in the DI group.Conclusion At 20 minutes prior to the end of laparoscopic radical resection of colon cancer,dexmedetomidine 1μg/kg can effectively inhibit stress responses during recovery period from general anesthesia and reduce the occurrence of adverse reactions.The nasal drip is simpler and safer,and significantly decreases the incidence of hypotension and bradycardia during the re-covery period,which is worthy of further clinical promotion.