右美托咪定复合利多卡因不同停药时间对妇科腹腔镜术后氧化应激、炎症因子及苏醒质量的影响  

Effects of different withdrawal time of dexmedetomidine combined with lidocaine on oxidative stress,inflammatory factors and recovery quality after gynecological laparoscopy

作　　者：刘宁 徐四七[1] 居霞[1] 刘宏亮 王兴 王胜斌[1] LIU Ning;XU Si-qi;JU Xia(Department of Anesthesiology,Anqing Municipal Hospital,Anqing 246000,China)

机构地区：[1]安庆市立医院麻醉科,安徽安庆246000

出　　处：《中国实验诊断学》2022年第12期1749-1754,共6页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨右美托咪定复合利多卡因不同停药时间对妇科腹腔镜术后氧化应激、炎症因子及苏醒质量的影响。方法选取2021年1月~12月于安庆市立医院妇科拟行腹腔镜手术的患者75例,采用随机数字表法分为A组、B组和C组,右美托咪定和利多卡因分别于术毕前30 min、20 min、10 min停药。比较3组不同时刻心率(HR),平均动脉压(MAP),比较3组插管后及拔管后2 h氧化应激[丙二醛(MDA)、总抗氧化水平(TAS)]和炎症因子[C反应蛋白(CRP)、白细胞介素(IL)-6]水平,比较3组苏醒质量,并统计不良反应发生情况。结果与诱导前(T1)相比,拔管时(T2)、拔管后10 min(T3)A组HR、MAP及T2时刻B组和C组HR、MAP均升高(P<0.05);与A组比较,B组和C组T2、T3时刻HR降低,T2时刻MAP降低,T3时刻MAP无变化(P<0.05)。与插管后比较,拔管后2 h 3组MDA、CRP和IL-6升高,TAS水平降低(P<0.05);B组和C组拔管后2 h MDA、CRP和IL-6低于A组,TAS水平高于A组(P<0.05),C组拔管后2 h TAS水平高于B组,CRP水平低于B组(P<0.05)。与A组比较,B组和C组苏醒时间、拔管时间均延长,疼痛(VAS)和躁动(RS)评分降低,镇静(Ramsay)评分升高(P<0.05),与B组比较,C组苏醒时间、拔管时间延长,Ramsay评分升高(P<0.05)。B组不良反应发生率低于A组(24.00%vs.52.00%,P<0.05);A组与C组之间无差异(44.00%vs.52.00%,P>0.05)。结论右美托咪定复合利多卡因在妇科腹腔镜手术结束前20 min停药,相较于手术结束前30 min停药有助于维持血流动力学稳定,减轻氧化应激和炎症反应,相较于手术结束前10 min停药有助于提高苏醒质量和安全性,推荐临床应用。Objective To investigate the effects of dexmedetomidine combined with lidocaine on oxidative stress,inflammatory factors and recovery quality after gynecological laparoscopic surgery.Methods Seventy-five patients who underwent laparoscopic surgery in the gynecology department of our hospital from January to December 2021 were selected and randomly divided into group A,group B,and group C by random number table method.Dexmedetomidine and lidocaine,respectively The drug was discontinued 30 minutes,20 minutes,and 10 minutes before the end of the operation,25 cases in each.The heart rate(HR)and mean arterial pressure(MAP)at different times were compared.Serum oxidative stress[malondialdehyde(MDA),total antioxidant level(TAS)]and inflammatory factors[C-reactive protein(CRP),interleukin(IL)-6]were compared after intubation and 2 hours after extubation.The recovery quality of the three groups was compared,and the occurrence of adverse reactions was counted.Results Compared with before induction(T1),HR and MAP in group A at the time of extubation(T2)and 10 minutes after extubation(T3),and HR and MAP in groups B and C at T2 were all increased(P<0.05).Compared with group A,HR decreased at T2 and T3,MAP decreased at T2,and MAP remained unchanged at T3 in groups B and C(P<0.05).Compared with after intubation,MDA,CRP and IL-6 in the 3 groups increased and the TAS level decreased at 2 h after extubation(P<0.05).2 hours after extubation in group B and C,MDA,CRP and IL-6 were lower than those in group A,and the level of TAS was higher than that in group A(P<0.05).2 hours after extubation in group C,the level of TAS was higher than group B,and the level of CRP was lower than group B(P<0.05).Compared with group A,the recovery time and laryngeal mask removal time in groups B and C were prolonged,the scores of pain(VAS)and agitation(RS)were decreased,and the scores of sedation(Ramsay)were increased(P<0.05).Compared with group B,the recovery time and laryngeal mask removal time in group C were prolonged,and the Ramsay score was incre

关 键 词：右美托咪定复合利多卡因 停药时间 妇科腹腔镜手术 氧化应激 炎症因子 苏醒质量 

分 类 号：R614.2[医药卫生—麻醉学]