右美托咪定辅助全麻对直肠癌根治术患者的镇静镇痛效果及对血流动力学的影响

Sedative and Analgesic Effects of Dexmedetomidine Assisted General Anesthesia on Patients Undergoing Radical Resection of Rectal Cancer and Its Influence on Hemodynamics

目的探讨右美托咪定辅助全麻对直肠癌根治术后患者的镇痛镇静效果及对血流动力学的影响。方法选取直肠癌根治术患者106例,随机分为对照组及观察组,各53例。对照组采用基础全身麻醉,观察组在此基础上加用右美托咪定。采用疼痛视觉评分(VAS)评估术后1 h、术后2 h、术后4 h及术后12 h的疼痛程度,采用镇静评分(Ramsay)评估术后1 h、术后2 h、术后4 h的镇静程度,比较不同时间点的血流动力学指标[舒张压(DBP)、收缩压(SBP)、心率(HR)]及血浆肾上腺素(E)、去甲肾上腺素(NE)水平,比较2组术后不良反应。结果观察组术后1 h、术后2 h、术后4 h VAS评分均低于对照组(P<0.05);观察组术后1 h、术后2 h的Ramsay评分均高于对照组(P<0.05),术后4 h Ramsay评分无差异(P>0.05)。2组T_(1)、T_(2)、T_(3)时刻的DBP、SBP、HR均依次降低(P<0.05),T_(4)、T_(5)、T_(6)时刻的DBP、SBP、HR均依次升高(P<0.05);观察组T_(2)、T_(3)、T_(4)、T_(5)及T_(6)时刻的DBP、SBP、HR均高于对照组(P<0.05)。观察组T_(2)、T_(3)、T_(5)时刻的血浆E、NE水平均依次升高(P<0.05),且T_(3)、T_(5)时刻的血浆E、NE水平均低于对照组(P<0.05)。2组术后不良反应发生率无差异(P>0.05)。结论右美托咪定辅助全麻对直肠癌根治术后患者具有较好的镇静镇痛效果,能够有效降低血流动力学波动以及血浆E、NE水平改变。

Objective To investigate the sedative and analgesic effects of dexmedetomidine assisted general anesthesia on patients with rectal cancer undergoing radical resection and its influence on hemodynamics.Methods A total of 106 patients underwent radical resection of rectal cancer were randomly divided into the control group and the observation group,53 cases in each.The control group was given basic general anesthesia,and the observation group was given dexmedetomidine on this basis.The pain visual score(VAS)was used to evaluate the pain degree at 1 hour,2 hours,4 hours and 12 hours after operation.The sedation score(Ramsay)was used to evaluate the degree of sedation 1 hour,2 hours and 4 hours after operation.The hemodynamic indexes[diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)],plasma adrenaline(E)and noradrenaline(NE)levels at different time points were compared,and the postoperative adverse reactions of the 2 groups were compared.Results The VAS scores in the observation group at 1 hour,2 hours and 4 hours after operation were lower than those in the control group(P<0.05).The Ramsay scores of the observation group were higher than those of the control group at 1 h and 2 h after surgery(P<0.05),but there was no difference in Ramsay scores at 4 h after surgery(P>0.05).DBP,SBP and HR at T_(1),T_(2)and T_(3)decreased successively in both groups(P<0.05),DBP,SBP and HR at T_(4),T_(5)and T_(6) increased in both groups(P<0.05),DBP,SBP and HR of observation group at T_(2),T_(3),T_(4),T_(5)and T_(6) were higher than those of the control group(P<0.05).The plasma E and NE levels of the observation group were increased at T_(2),T_(3)and T_(5)moments(P<0.05),and the plasma E and NE levels at T_(3)and T_(5)moments were lower than those of the control group(P<0.05).There was no difference in the incidence of adverse reactions between the 2 groups(P>0.05).Conclusions Dextrmedetomidine assisted general anesthesia has a good sedative and analgesic effect on patients after radical resection of rectal cancer,and can effectively reduce hemodynamic fluctuations and changes in plasma E and NE levels.