右美托咪定在肝癌手术患者中的应用效果

Application effect of dexmedetomidine in patients with liver cancer undergoing surgery

目的探讨右美托咪定(DEX)在肝癌手术患者中的应用效果。方法依据麻醉诱导前是否使用DEX将98例肝癌手术患者分为观察组(n=46)和对照组(n=52)。观察组患者在麻醉诱导前15 min给予1.0μg/kg的DEX,对照组患者在麻醉诱导前15 min给予等量的0.9%氯化钠溶液。比较两组患者的疼痛指标[神经肽Y(NPY)、P物质(SP)、多巴胺(DA)]、血流动力学指标[心率(HR)、平均动脉压(MAP)]、胃肠功能指标[胃泌素(GAS)、胃动素(MTL)、胆囊收缩素(CCK)]、术后恢复指标及术后院内感染情况。结果手术后3天,两组患者NPY、SP、DA水平均高于本组手术前,观察组患者NPY、SP、DA水平均低于对照组,差异均有统计学意义(P﹤0.05)。麻醉诱导后(T1)至手术后2 h(T4),观察组患者MAP、HR均明显低于对照组,差异均有统计学意义(P﹤0.01)。手术后3天,两组患者CCK水平均高于本组手术前,GAS、MTL水平均低于本组手术前,观察组患者GAS、MTL水平均高于对照组,CCK水平低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的苏醒时间、首次下床活动时间、首次肛门排气时间、首次排便时间、术后住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01)。观察组患者的术后院内感染率低于对照组,差异有统计学意义(P﹤0.05)。结论麻醉诱导前给予DEX对肝癌手术患者具有良好的镇痛效果,对患者的血流动力学和胃肠功能影响较小,可以促进患者术后恢复并且降低术后院内感染率。

Objective To investigate the application effect of dexmedetomidine(DEX)in patients with liver cancer undergoing surgery.Method A total of 98 patients with liver cancer undergoing surgery were divided into observation group(n=46)and control group(n=52)according to whether DEX was used before induction of anesthesia.The observation group was given 1.0μg/kg DEX 15 min before anesthesia induction,and the control group was given the same amount of 0.9%sodium chloride solution 15 min before anesthesia induction.The pain indexes[neuropeptide Y(NPY),substance P(SP),dopamine(DA)],hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)],gastrointestinal function indexes[gastrin(GAS),motilin(MTL),cholecystokinin(CCK)],postoperative recovery indexes and nosocomial infection were compared between the two groups.Result Three days after surgery,the levels of NPY,SP and DA in two groups were higher than those before surgery,the levels of NPY,SP and DA in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).After anesthesia induction(T1)to 2 h after operation(T4),the MAP and HR in observation group were significantly lower than those in control group,and the differences were statistically significant(P<0.01).Three days after surgery,the levels of CCK in two groups were higher than those before surgery,and the levels of GAS and MTL in the two groups were lower than those before surgery,the levels of GAS and MTL in the observation group were higher than those in control group,the level of CCK in observation group was lower than that in control group,and the differences were statistically significant(P<0.05).The recovery time,first getting out of bed time,first anal exhaust time,first defecation time and postoperative hospitalization time in observation group were significantly shorter than those in control group,and the differences were statistically significant(P<0.01).The postoperative nosocomial infection rate of observation group was lower than that of control group,and the difference was statistically significant(P<0.05).Conclusion DEX before induction of anesthesia has good analgesic effect on patients undergoing surgery for liver cancer,has little effect on hemodynamics and gastrointestinal function of pa-tients,can promote postoperative recovery of patients and reduce postoperative nosocomial infection rate.