右美托咪定联合瑞芬太尼对甲状腺癌根治术患者的应激反应及术后早期镇痛效果的影响

Effects of Dexmedetomidine Combined with Remifentanil on Stress Response and Early Postoperative Analgesia in Patients Undergoing Radical Thyroidectomy

探讨右美托咪定联合瑞芬太尼对甲状腺癌根治术患者应激反应与术后早期镇痛效果的影响。选取医院2020年6月至2022年10月收治的甲状腺癌患者102例,择期行甲状腺癌根治术,根据随机抽签方法分成A组与B组各51例。两组均于准备手术时给予0.5μg/kg(10 min内)右美托咪定泵入,术毕给予瑞芬太尼靶控输注,A组瑞芬太尼血浆靶控质量浓度调整为1.5 ng/mL,B组为1.0 ng/mL。比较两组麻醉诱导前(T0)、插管前(T1)、插管后1 min(T2)、拔管时(T3)的心率(HR)、平均动脉压(MAP)、脉氧饱和度(SpO_(2))变化。分别在手术前后检测两组血清皮质醇(Cor)、去甲肾上腺素(NE)、超氧化物歧化酶(SOD)、丙二醛(MDA)及P物质(SP)、多巴胺(DA)、前列腺素E_(2)(PGE_(2))水平。利用视觉模拟疼痛评分(VAS)评估术后早期镇痛效果,比较两组不良反应情况。B组T3的HR、MAP高于A组,SpO_(2)低于A组(P<0.05)。两组术毕即刻、术后12 h、术后24 h的血清Cor、NE、MDA水平高于术前,A组低于B组;且两组术毕即刻及术后12、24 h的血清SOD水平低于术前,A组高于B组(P<0.05)。两组术毕即刻、术后12 h、术后24 h的血清SP、DA、PGE_(2)水平高于术前,且A组低于B组(P<0.05);A组术毕即刻及术后12、24 h的VAS评分低于B组(P<0.05);A组(9.80%)不良反应率与B组(13.73%)比较无差异(P>0.05)。准备手术时给予右美托咪定联合术毕瑞芬太尼血浆靶控质量浓度1.5 ng/mL持续泵入,能减轻甲状腺癌根治术患者的应激反应,提升术后早期镇痛效果,安全性高。

To investigate the effects of dexmedetomidine combined with remifentanil on stress response and early postoperative analgesia in patients with thyroid cancer undergoing radical surgery,102 patients with thyroid cancer admitted to the hospital from June 2020 to October 2022 were selected to receive radical thyroidectomy,and were divided into group A and Group B with 51 cases in each group according to random drawing method.In both groups,0.5μg/kg(within 10 min)dexmedetomidine was pumped during preparation for surgery,and target-controlled infusion of remifentanil was given after surgery.The plasma target-controlled concentration of remifentanil in group A and group B was adjusted to 1.5 ng/mL and 1.0 ng/mL respectively.The changes of heart rate(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO_(2))before anesthesia induction(T0),before intubation(T1),1 min after intubation(T2)and at extubation(T3)were compared between the two groups.The levels of serum cortisol(Cor),norepinephrine(NE),superoxide dismutase(SOD),malondialdehyde(MDA),substance P(SP),dopamine(DA)and prostaglandin E_(2)(PGE_(2))in the two groups were detected before and after surgery,and visual analogue pain scale(VAS)was used to evaluate the early postoperative analgesia.The adverse reactions of the two groups were compared.HR and MAP of T3 in group B were higher than those in group A,and SpO_(2) was lower than those in group A(P<0.05).The levels of serum Cor,NE and MDA in two groups immediately after surgery,12 h and 24 h after surgery were higher than those before surgery,and the levels of serum SOD in two groups immediately after surgery,12 h and 24 h after surgery were lower than those before surgery,and the levels in group A were higher than those in group B(P<0.05).Serum SP,DA and PGE_(2) levels in both groups were higher immediately after surgery,12 h and 24 h after surgery than before surgery,and those in group A was lower than those in group B(P<0.05).The VAS scores of group A immediately after surgery and 12 h,24 h after surgery were lower than those of group B(P<0.05).There was no difference in adverse reaction rate between group A(9.80%)and group B(13.73%)(P>0.05).When preparing for surgery,dexmedetomidine combined with pirifentanil with plasma target control concentration of 1.5 ng/mL can reduce the stress response of patients undergoing radical thyroidectomy,improve the early postoperative analgesia effect,and have high safety.