静脉全麻下老年患者腹腔镜结直肠癌手术辅用右美托咪啶的临床对照研究  

Clinical control study of dexmedetomidine in the treatment of elderly patients during laparoscopy surgery for colorectal cancer under intravenous anesthesia

作　　者：吴亮春[1] 汤洁[1] 邵永斌[1] 肖勇[1] 

机构地区：[1]武警安徽总队医院麻醉科,合肥230041

出　　处：《中华灾害救援医学》2017年第6期325-328,共4页Chinese Journal of Disaster Medicine

摘　　要：目的观察辅用右美托咪啶对静脉全麻下老年患者腹腔镜结直肠癌手术中血流动力学、全麻药物用量及术后苏醒时间的影响,为右美托咪啶在该类手术中的应用提供临床依据。方法选择2015-10至2016-10武警安徽总队医院收治的48例接受腹腔镜结直肠癌手术的老年患者为研究对象,按随机数字表法分为研究组与对照组,每组24例。研究组在麻醉诱导前以0.4μg/kg的剂量静脉泵注右美托咪啶,对照组泵注等体积生理盐水。观察并比较两组手术时间、出血量、术中麻药用量、术后苏醒时间与不良反应的发生率,以及在入室时(T_0)、泵注负荷量的右美托咪啶后(T_1)、气管插管后即刻(T_2)、插管后3 min(T_3)、气腹时(T_4)、气腹后60 min(T_5)、气管拔管后即刻(T_6)、气管拔管后5 min(T_7)、气管拔管后60 min(T_8)时间点的平均动脉压(mean artery pressure,MAP)和心率。结果 (1)两组手术时间及术中出血量的比较差异无统计学意义;(2)研究组MAP与心率在T_1时间点较T0时刻明显下降(t=2.787,P=0.004;t=3.164,P=0.002);对照组MAP与心率在T_2~T_8时间点较T_0升高(P<0.0063),且在术后T_1~T_8时间点均明显高于研究组(P<0.0056);(3)研究组术中麻醉药用量明显较对照组少(P<0.05);两组术后苏醒时间与不良反应发生率的比较差异无统计学意义。结论静脉全麻下行腹腔镜结直肠癌手术的老年患者,术中辅用右美托咪啶在一定剂量范围内不仅可保持患者血流动力学平稳,还可显著减少术中麻醉药物的用量,且无明显苏醒延迟。Objective The study objective was to observe the effect of dexmedetomidine on intraoperative hemodynamics, dosage of general anesthesia drug and the time of postoperative palinesthesia in elderly patients during laparoscopic colorectal surgery under intravenous anesthesia, and to provide clinical evidence for the use of dexmedetomidine in this kind of operation. Methods A total sample of 48 elderly patients undergoing laparoscopic colorectal surgery in Anhui Provincial Corps Hospital from October 2015 to October 2016 were chosen as study objects and divided into study group and control group by using the random number table method, 24 cases in each group. The study group were administered with intravenous infusion of dexmedetomidine in a dose of 0.4 μg/kg before anesthesia induction and the control group were administered with an equal volume of normal saline. The operation time, blood loss, dosage of general anesthesia, time of postoperative palinesthesia and incidence of adverse reactions in the two groups were recorded, as well as the mean arterial pressure （MAP） and heart rate （HR） of the two groups on the admission to operating room （T0）, after receiving a loading dose of dexmedetomidine （T1）, immediately after endotracheal intubation （T2）, 3 min after endotracheal intubation （T3）, at the time of pneumoperitoneum （T4）, 60 min after pneumoperitoneum （T5）, immediately after extubation （T6）, 5 min after extubation （T7）, and 60 min after extubation （T8）. Results （1） There was no significant difference in operation time and blood loss between the two groups; （2） The MAP and HR of the study group at T1 were decreased significantly as compared to the time point of T0 （t=2.787, P=0.004; t=3.164, P=0.002）; The MAP and HR of the control group from the T2 time point of to the T8 time point were significantly increased as compared to the time point of T0 （P〈0.0063）; and the MAP and HR of the control group from the T1 time point to the T8 time poi

关 键 词：右美托咪啶 静脉全麻 腹腔镜结直肠癌手术 

分 类 号：R971.2[医药卫生—药品]