右美托咪定辅助全麻对胃癌手术患者的效果研究

Effect of Dexmedetomidine and Anesthesia on Patients Treated with Gastric Cancer Surgery

目的探讨静脉注射右美托咪定辅助全身麻醉对胃癌根治手术患者的血流动力学、麻醉药用量以及术后镇静镇痛的影响。方法将全麻下行胃癌根治术患者60例,随机分为试验组和对照组(n=30);试验组麻醉诱导前15min静脉注入右美托咪定0.6μg/kg,维持为0.4μg/kg,直至术毕前40 min;对照组则给予等量的生理盐水。观察注药前(T1)、麻醉诱导前(T2)、气管插管前即刻(T3)、插管后1 min(T4)、切皮时(T5)、探查时(T6)、拔管后即刻(T7)的脑双频指数(BIS)、平均动脉压(MAP)、心率(HR),记录丙泊酚和瑞芬太尼的用量,评价术后1 h内的苏醒躁动程度评分、镇静评分和视觉模拟评分情况。结果 T1-5两组BIS、HR和BP值呈现降低趋势;与对照组比较,试验组T2时BIS、T2和T4-7时MAP明显降低,以及HR明显减慢。试验组丙泊酚和瑞芬太尼的用量明显低于对照组(P<0.05);试验组术后1h的Ramsay评分明显高于对照组、RS和VAS评分明显低对照组(P<0.05)。结论右美托咪定辅助全身麻醉应用于胃癌根治术中更易于维持血流动力学的稳定,有明显镇静、镇痛效应,减少麻醉药的用量,降低了患者术后的不适感。

Objective To evaluate the effect of intravenous dexmedetomidine assisted in general anesthesia on hemodynamics,the amount of anesthetic,postoperative sedation and analgesia in radical gastrectomy. Methods 60 patients scheduled for radical gastrectomy under general anesthesia were randomly divided into the test group( n = 30) and the control group( n = 30).In test group,0. 6 μg / kg of dexmedetomidine was injected intravenously by micro-pump 15 minutes before induction of anesthesia,then 0. 4 μg /( kg·h) was maintained until 40 minutes before the end of operation. While in the control group,the same volume of normal saline was given by the same way. The parameters of BIS,MAP and HR before infusion( T1),before the induction of anesthesia( T2),immediately after intubation( T3),1 min after intubation( T4),immediately after skin incision( T5),immediately after operation exploration( T6),immediately after extubation( T7) of the 2 groups were recored. The amount of propofol and remifentanil were recorded. The parameters of RS,Ramsay and VAS within 1 hour after operation were recorded. Results BIS,HR and BP values at T1-5 of the 2 groups showed a decreasing trend. Compared with the control group,the BIS values of the test group at T2 slowed significantly,while the MAP and HR values of the test group at T2,T4-T7 slowed significantly. Propofol and remifentanil consumption in the test group were less than those of the control group. 1 h after operation,the Ramsay score in the test group was significantly higher than that of the control group,while the RS and VAS score in the test group were significantly lower than those of the control group. Conclusion The application of dexmedetomidine assisted in general anesthesia can maintain hemodynamic stability,reduce the amount of anesthetic,produce significant postoperative sedation and analgesia,and reduce postoperative discomfort.