右美托咪定联合地氟醚麻醉对肝癌手术患者脑氧代谢、镇静深度及脑功能的影响  

Effects of dexmedetomidine combined with desflurane anesthesia on cerebral oxygen metabolism,sedation depth and cerebral function in patients undergoing liver cancer surgery

作　　者：徐刚 黄媛媛 任柏林 刘俊鹏 卢锡华 廖长虹 XU Gang;HUANG Yuanyuan;REN Bolin;LIU Junpeng;LU Xihua;LIAO Changhong(Department of Anesthesia and Perioperative Medicine,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China;Department of Anesthesia,Zhongshan Hospital,Fudan University,Shanghai 200000,China)

机构地区：[1]郑州大学附属肿瘤医院麻醉与围术期医学科,河南郑州450000 [2]复旦大学附属中山医院麻醉科,上海200000

出　　处：《新乡医学院学报》2024年第2期175-179,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨右美托咪定联合地氟醚麻醉对行肝叶部分切除术肝癌患者脑氧代谢、镇静深度及脑功能的影响。方法选择2022年3至9月在郑州大学附属肿瘤医院行肝叶部分切除术的30例肝癌患者为研究对象。按麻醉方法不同将患者分为对照组(n=15)和观察组(n=15)。2组患者均行开腹肝叶部分切除术。2组患者采用相同麻醉诱导方法,对照组患者给予地氟醚进行麻醉维持,观察组患者给予右美托咪定联合地氟醚进行麻醉维持。比较2组患者术后苏醒时间、自主呼吸恢复时间、呼之睁眼时间等麻醉恢复指标;分别于麻醉诱导前(T_(0))、麻醉诱导完成时(T_(1))、肝门阻断后10 min(T_(2))、肝叶切除后(T_(3))、手术结束后(T_(4)),使用血气分析仪检测2组患者动脉血氧饱和度(SaO_(2))、颈静脉血氧饱和度(SjvO_(2))、动脉血氧分压(PaO_(2))、静脉血氧分压,并计算颈动、静脉血氧含量差(AVDO_(2))及脑氧摄取率(CEO_(2));分别于T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时采用脑电双频指数(BIS)和患者状态指数(PSI)评估2组患者镇静深度;采用匹兹堡脑功能分级量表评估2组患者术后3个月脑功能;比较2组患者术后不良反应发生率。结果观察组患者苏醒时间、自主呼吸恢复时间及呼之睁眼时间均显著短于对照组(P<0.05)。2组患者不同时间点SaO_(2)比较差异均无统计学意义(P>0.05);T_(2)、T_(3)时,观察组患者的SjvO_(2)、AVDO_(2)及CEO_(2)均显著低于对照组(P<0.05);其余时间点2组患者SjvO_(2)、AVDO_(2)及CEO_(2)比较差异均无统计学意义(P>0.05)。T_(2)、T_(3)、T_(4)时,观察组患者BIS和PSI均显著低于对照组(P<0.05);T_(0)、T_(1)时2组患者BIS、PSI比较差异无统计学意义(P>0.05)。对照组患者术后脑功能分级Ⅰ级11例,Ⅱ级3例,Ⅲ级1例;观察组患者术后脑功能分级Ⅰ级12例,Ⅱ级3例;2组患者术后脑功能分级比较差异无统计学意义(χ^(2)=1.044,P>0.05)。对照组和观�Objective To explore the effects of dexmedetomidine combined with desflurane anesthesia on cerebral oxygen metabolism,sedation depth and cerebral function in liver cancer patients undergoing partial hepatic lobectomy.Methods A total of 30 liver cancer patients undergoing partial hepatic lobectomy at the Affiliated Cancer Hospital of Zhengzhou University from March to September 2022 were selected as the research subjects,they were divided into control group(n=15)and observation group(n=15)according to different anesthesia methods.Patients in both groups underwent partial open hepatectomy,and they were given the same anesthesia induction method.The patients in the control group received desflurane for anesthesia maintenance,while patients in the observation group received dexmedetomidine combined with desflurane for anesthesia maintenance.The anesthesia recovery indexes including the postoperative recovery time,recovery time of spontaneous breathing,eye-opening time of patients between the two groups were compared.The arterial oxygen saturation(SaO_(2)),cervical vein oxygen saturation(SjvO_(2)),arterial partial pressure of oxygen(PaO_(2))and partial pressure of venous oxygen of patients were detected by blood gas analyzer before anesthesia induction(T_(0)),at the completion of anesthesia induction(T_(1)),at 10 minutes after hepatic portal occlusion(T_(2)),after hepatic lobectomy(T_(3))and after surgery(T_(4)),and arterio-venous oxygen content difference(AVDO_(2))and cerebral oxygen extraction rate(CEO_(2))were calculated.The sedation depth of patients was evaluated by bispectral index(BIS)and patient state index(PSI)at T_(0),T_(1),T_(2),T_(3) and T_(4).The cerebral function of patients was evaluated by the Glasgow-Pittsburgh cerebral performance category scale at 3 months after surgery.The incidence of postoperative adverse reactions of patients between the two groups was compared.Results The postoperative recovery time,recovery time of spontaneous breathing and eye-opening time of patients in the observation group

关 键 词：右美托咪定 地氟醚 肝癌 脑氧代谢 

分 类 号：R614.2[医药卫生—麻醉学]