右美托咪定与硬膜外阻滞复合全身麻醉用于胸腔镜肺癌手术患者的效果比较  

Comparison of the effect of dexmedetomidine and epidural anesthesia combined general anesthesia on patients undergoing thoracoscopic lung cancer surgery

作　　者：冯燕玲 管忍 费建芬 FENG Yanling;GUAN Ren;FEI Jianfen(Department of Anesthesiology,Changshu Hospital Affiliated to Suzhou University/the First People's Hospital of Changsha,Jiangsu Province,Changshu 215500,China)

机构地区：[1]苏州大学附属常熟医院/常熟市第一人民医院麻醉科,江苏省常熟市215500

出　　处：《临床合理用药杂志》2021年第34期13-15,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的比较右美托咪定复合全身麻醉与硬膜外阻滞复合全身麻醉用于胸腔镜肺癌手术患者的效果。方法选择2020年1-12月于苏州大学附属常熟医院/常熟市第一人民医院行胸腔镜下肺癌根治术患者50例为研究对象,根据随机数字表法分为右美托咪定组和硬膜外阻滞组,每组25例。右美托咪定组患者采用右美托咪定复合全身麻醉,硬膜外阻滞组采用硬膜外阻滞复合全身麻醉,比较2组患者临床指标、治疗前后炎性因子水平及不良反应。结果 2组手术时长、住院时间、丙泊酚用量比较差异均无统计学意义(P> 0.05);右美托咪定组补液量少于硬膜外阻滞组(P<0.01),而舒芬太尼用量、镇痛评分高于硬膜外阻滞组(P<0.01)。术后24 h,2组白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α水平均高于麻醉诱导前(P<0.01),但组间比较差异无统计学意义(P> 0.05)。2组恶心、呕吐、心动过缓发生率比较差异无统计学意义(P> 0.05);硬膜外阻滞组低血压、腰背痛发生率高于右美托咪定组(P<0.05)。结论胸腔镜肺癌手术患者使用右美托咪定或硬膜外阻滞复合全身麻醉,均可改善患者炎性因子水平,其中右美托咪定复合全身麻醉可减少术中补液量,且患者产生低血压和腰背痛的情况更少,而硬膜外阻滞复合全身麻醉舒芬太尼使用量更少,镇痛效果更好,两种麻醉方式各有优劣性,可根据患者实际情况和具体需求择优选择。Objective To compare the efficacy of dexmedetomidine combined with general anesthesia and epidural block combined with general anesthesia in patients undergoing thoracoscopic lung cancer surgery.Methods Fifty patients who underwent thoracoscopic radical resection of lung cancer in Changshu Hospital Affiliated to Suzhou University/The First People’s Hospital of Changshu from January to December 2020 were selected as the research subjects. They were divided into dexmedetomidine group and epidural block group according to random number table method, with 25 patients in each group.Dexmedetomidine group received dexmedetomidine combined with general anesthesia, epidural block group received epidural block combined with general anesthesia. The clinical indexes, inflammatory factors and adverse reactions were compared between 2 groups.Results There were no significant differences in operation duration, hospital stay and dosage of propofol between 2 groups(P> 0. 05). The amount of fluid in dexmedetomidine group was less than that in epidural block group(P<0. 01), while the amount of sufentanil and analgesia score were higher than that in epidural block group(P< 0. 01). 24 h after surgery, the levels of interleukin-6, interleukin-10 and tumor necrosis factor-α in both groups were higher than those before anesthesia induction(P< 0. 01), but there were no significant difference between groups(P> 0. 05). There were no significant difference in the incidence of nausea, vomiting and bradycardia between the two groups(P> 0. 05). The incidence of hypotension and back pain in epidural block group were higher than that in dexmedetomidine group(P< 0. 05).Conclusion Both dexmedetomidine and epidural block combined with general anesthesia in patients undergoing thoracoscopic lung cancer surgery can improve the levels of inflammatory factors in patients, among which dexmedetomidine combined with general anesthesia can reduce intraoperative fluid replacement, and patients have less hypotension and low back pain. However, epidural bl

关 键 词：胸腔镜肺癌手术 全身麻醉 右美托咪定 硬膜外阻滞 炎性因子 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]