右美托咪定复合利多卡因对全身麻醉复合PVB下胸腔镜食管癌根治术炎性反应的影响  

Effects of intravenous infusion of dexmedetomidine combined with lidocaine on inflammatory response in thoracoscopic radi⁃cal resection for esophageal carcinoma under general anesthesia combined with paravertebral nerve block

作　　者：张小亮[1] 梁海丹[1] 刘成森[1] Zhang Xiaoliang;Liang Haidan;Liu Chengsen(Zone Two of Anesthesiology,Gaozhou People's Hospital,Gaozhou 525200,China)

机构地区：[1]高州市人民医院麻醉二区,525200

出　　处：《国际麻醉学与复苏杂志》2021年第8期818-822,共5页International Journal of Anesthesiology and Resuscitation

基　　金：茂名市科技计划项目(2020004)。

摘　　要：目的探讨静脉输注右美托咪定复合利多卡因对全身麻醉复合椎旁神经阻滞(paravertebral nerve block,PVB)下胸腔镜食管癌根治术患者炎性反应的影响。方法2018年8月—2020年8月在高州市人民医院实施全身麻醉复合PVB下胸腔镜食管癌根治术的患者100例,按随机数字表法分为对照组、右美托咪定组、利多卡因组及复合组,每组25例。4组患者均于麻醉诱导前行PVB。右美托咪定组、利多卡因组分别于麻醉诱导前10 min静脉输注右美托咪定0.5μg/kg、2%盐酸利多卡因1.5 mg/kg,10 min内输注完毕,后分别以0.4μg·kg^(−1)·h^(−1)和1.5 mg·kg^(−1)·h^(−1)的剂量维持至手术结束前30 min;复合组麻醉诱导前10 min输注右美托咪定+2%盐酸利多卡因,方法剂量同前;对照组静脉输注等剂量生理盐水。记录4组患者的手术时间、麻醉时间、苏醒时间、拔管时间、丙泊酚用量及瑞芬太尼用量,比较4组患者诱导前(T_(1))、手术完成时(T_(2))、术后2 h(T3)、术后24 h(T4)血清IL⁃6和TNF⁃α水平,观察4组患者不良反应发生情况。结果4组患者手术时间、麻醉时间比较,差异均无统计学意义(P>0.05);与对照组和利多卡因组比较,右美托咪定组和复合组的苏醒时间、拔管时间增加,丙泊酚及瑞芬太尼用量减少(P<0.05),复合组的改变幅度更大。T_(1)时4组血清IL⁃6、TNF⁃α水平差异无统计学意义(P>0.05);T_(2)~T4时,4组血清IL⁃6、TNF⁃α水平均较T_(1)时升高(P<0.05)。T3~T4时,利多卡因组的血清TNF⁃α水平低于对照组(P<0.05);T_(2)~T4时,与对照组和利多卡因组比较,右美托咪定组和复合组血清IL⁃6、TNF⁃α水平降低(P<0.05),复合组的改变幅度更大。4组患者均未发生严重不良反应。结论静脉输注右美托咪定复合利多卡因能够明显减轻全身麻醉复合PVB下胸腔镜食管癌根治术患者的炎性反应。Objective To discuss the effect of intravenous infusion of dexmedetomidine combined with lidocaine on inflamma⁃tory response in thoracoscopic radical resection for esophageal carcinoma under general anesthesia combined with paravertebral nerve block(PVB).Methods According to the random number table method,100 patients who suffered from esophageal carcinoma and received thoracoscopic radical resection under general anesthesia combined with PVB in Gaozhou People's Hospital from August 2018 to August 2020 were enrolled.They were divided into four groups(n=25):a control group,a dexmedetomidine group,a lidocaine group and a combination group.All patients underwent PVB before induction of anesthesia.Then,10 min before induction of anesthesia,the dexmedetomidine group and lidocaine group were intravenously infused with 0.5μg/kg dexmedetomidine or 2%lidocaine hydrochlo⁃ride at 1.5 mg/kg within 10 min,followed by a maintain dose of 0.4μg·kg^(−1)·h^(−1) or 1.5 mg·kg^(−1)·h^(−1)30 min before the end of the opera⁃tion.The combination group was infused with dexmedetomidine and 2%lidocaine hydrochloride 10 min before anesthesia induction at the same dosing methods mentioned above.The control group was intravenously infused with the same dose of normal saline.Their op⁃eration time,anesthesia time,recovery time,extubation time,propofol dosage and remifentanil dosage were recorded.Their levels of se⁃rum interleukin⁃6(IL⁃6)and tumor necrosis factor(TNF⁃α)were compared among the four groups before induction(T_(1)),at the end of op⁃eration(T_(2)),2 h after surgery(T_(3))and 24 h after surgery(T_(4)).The adverse reactions were recorded.Results There was no statistical difference in operation time and anesthesia time among the four groups (P>0.05). Compared with the control group and lidocaine group,the dexmedetomidine group and combination group showed remarkable increases in recovery time and extubation time, and decreasesin the doses of propofol and remifentanil (P<0.05), where the changes in the co

关 键 词：胸腔镜检查 食管癌根治术 右美托咪定 利多卡因 麻醉 全身 椎旁神经阻滞 炎性反应 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]