右美托咪定在胃癌根治术全凭静脉麻醉用药中的应用效果及安全性分析

Analysis of the Effect and Safety of Dexmedetomidine in Total Intravenous Anesthesia for Radical Gastrectomy

关键词:  胃癌根治手术  麻醉  全凭静脉麻醉  右美托咪定

Key words:  radical gastrectomy  anesthesia  total intravenous anesthesia  dexmedetomidine

摘要:

目的 探讨右美托咪定在胃癌根治术全凭静脉麻醉用药中的应用效果及安全性。方法 选取2018年7月—2020年6月湖州市中心医院收治的120例胃癌根治手术患者作为研究对象，采取随机数字表法将患者分组，对照组和观察组各60例。2组患者术中麻醉方式均选择气管插管全身麻醉，对照组麻醉诱导采用丙泊酚+舒芬太尼+罗库溴铵，观察组在对照组基础上应用右美托咪定，比较2组患者的麻醉优良率、生命体征指标、术后麻醉苏醒时间、术后不良反应发生率、认知功能评分、术后疼痛评分。结果 2组患者的麻醉优良率比较，差异无统计学意义。与插管前相比，2组患者插管后的收缩压、舒张压、心率均未发现明显变化；插管后，2组患者之间的收缩压、舒张压、心率比较，差异均无统计学意义。观察组的术后自主呼吸恢复时间、睁眼时间、指令恢复时间均较对照组显著缩短(P<0.05)。观察组的术后不良反应发生率为1.67%，对照组为11.67%，观察组显著低于对照组(P<0.05)。与手术前相比，2组患者的MMSE、MoCA评分在手术后均显著降低(P<0.05)；手术后，观察组的MMSE、MoCA评分均较对照组显著提高(P<0.05)。在术后4，8，12 h，观察组在静息、咳嗽时的疼痛评分均较对照组显著降低(P<0.05)。结论 右美托咪定在胃癌根治手术全凭静脉麻醉中的应用可维持患者生命体征稳定，确保术中麻醉效果良好，还可减少不良反应，达到良好的术后镇痛效果。

Abstract:

OBJECTIVE To investigate the effect and safety of dexmedetomidine in total intravenous anesthesia for radical gastrectomy. METHODS One hundred and twenty cases of patients who undergoing radical gastrectomy in Huzhou Central Hospital from July 2018 to June 2020 were selected as the research objects, and were randomly divided into control group and observation group with 60 cases each. Two groups of patients were given general anesthesia by tracheal intubation, propofol+sufentanil+ rocuronium were used for anesthesia induction in the control group, and dexmedetomidine was used in the observation group on the basis of the control group. The anesthesia excellent and good rate, vital signs, postoperative anesthesia recovery time, postoperative adverse reaction rate, cognitive function score and postoperative pain score were compared between the two groups. RESULTS There was no significant difference in the excellent and good rate of anesthesia between the two groups. Compared with before intubation, systolic blood pressure, diastolic blood pressure and heart rate of the two groups did not change significantly after intubation. After intubation, there was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the two groups. The recovery time of spontaneous breathing, eye opening and command in the observation group were significantly shorter than those in the control group (P<0.05). The incidence of postoperative adverse reactions was 1.67% in the observation group and 11.67% in the control group, which was significantly lower than that in the control group (P<0.05). Compared with pre-operation, MMSE and MoCA scores of patients in both groups decreased significantly after operation (P<0.05). After operation, MMSE and MoCA scores of observation group were significantly higher than those of control group (P<0.05). At 4, 8, 12 h after operation, the pain scores of the observation group at rest and cough were significantly lower than those of the control group (P<0.05).CONCLUSION Dexmedetomidine in total intravenous anesthesia for radical gastrectomy can maintain the stability of patients’ vital signs, ensure good intraoperative anesthesia effect, reduce adverse reactions and achieve good postoperative analgesic effect.