老年患者腹腔镜结直肠癌根治术麻醉方法的改良:复合右美托咪定全身麻醉  

Improvement in strategy of anesthesia for laparoscopic radical resection of colorectal cancer in elderly patients:dexmedetomidine-based balanced anesthesia

作　　者：刘妹女 张梦 何金华 李建立[1] Liu Meinyu;Zhang Meng;He Jinhua;Li Jianli(Department of Anesthesiology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院麻醉科,石家庄050051

出　　处：《中华麻醉学杂志》2022年第4期426-429,共4页Chinese Journal of Anesthesiology

基　　金：河北省重点研发计划项目(19277714D)。

摘　　要：目的从术后转归角度,评价复合右美托咪定全身麻醉用于老年患者腹腔镜结直肠癌根治术的优化效应。方法择期全身麻醉下行腹腔镜结直肠癌根治术老年患者112例,性别不限,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=56):常规全身麻醉组(C组)和复合右美托咪定全身麻醉组(D组)。D组于麻醉诱导开始时经10 min静脉输注右美托咪定0.5μg/kg,随后依次静脉注射咪达唑仑、舒芬太尼、依托咪酯和苯磺顺阿曲库铵;麻醉维持使用七氟烷、瑞芬太尼和丙泊酚,静脉输注右美托咪定0.5μg·kg^(-1)·h^(-1)至术毕前30 min;C组以等量生理盐水代替右美托咪定用药,余同D组。于术前1 d、术后2、7 d时采集静脉血样检测血常规,计算中性粒细胞计数/淋巴细胞计数比值(NLR)。记录术中麻醉药物用量、术后麻醉相关并发症发生情况及术后首次排气时间和排便时间。结果与C组比较,D组术中丙泊酚及瑞芬太尼用量减少,术后2、7 d时NLR降低,术后谵妄及术后恶心呕吐发生率降低,术后首次排气时间及排便时间缩短(P<0.05)。结论复合右美托咪定全身麻醉用于腹腔镜结直肠癌根治术老年患者,较常规全身麻醉具有一定的优化效果,有利于术后早期转归。Objective To evaluate the optimization efficacy of dexmedetomidine-based balanced anesthesia for laparoscopic radical resection of colorectal cancer in elderly patients from the perspective of postoperative outcomes.Methods A total of 112 patients of both sexes,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective laparoscopic radical resection of colorectal cancer under general anesthesia,were divided into 2 groups(n=56 each)using a random number table method:conventional general anesthesia group(group C)and dexmedetomidine-based balanced anesthesia group(group D).In D group,dexmedetomidine was intravenously infused with a loading dose of 0.5μg/kg over 10 min starting from the beginning of anesthesia induction,and then midazolam,sufentanil,etomidate and cis-atracurium were injected sequentially,and anesthesia was maintained with sevoflurane,remifentanil and propofol,and dexmedetomidine 0.5μg·kg^(-1)·h^(-1) was continuously infused until 30 min before the end of surgery.In group C,the equal volume of normal saline was given instead of dexmedetomidine,and the other anesthetics were similar to those previously described in group D.Venous blood samples were collected on 1 day before surgery and 2 and 7 days after surgery for routine blood test to determine the neutrophil-to-lymphocyte ratio.The consumption of intraoperative anesthetics,anesthesia-related postoperative complications,and time to postoperative first flatus and first feces were recorded.Results Compared with group C,the consumption of intraoperative propofol and remifentanil was significantly reduced,neutrophil-to-lymphocyte ratio was decreased on 2 and 7 days after surgery,the incidence of postoperative delirium,nausea and vomiting was decreased,and the time to postoperative first flatus and first feces was shortened in group D(P<0.05).Conclusions Dexmedetomidine-based balanced anesthesia has a certain improvement in the efficacy and is more helpful for early postoperative outcomes than conventional general anesthe

关 键 词：右美托咪啶 麻醉 全身 炎症 结直肠肿瘤 腹腔镜检查 老年人 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]