围手术期应用右美托咪定对乳腺癌根治术后疼痛、氧化应激及不良反应的影响  

Effects of dexmedetomidine in perioperative period on pain,oxidative stress and adverse reactions after radical breastcancer surgery

作　　者：李红[1] 刘健健 魏淑敏 西牧姣 张发展[2] 宗守凯[3] 迟娜娜[4] 曹清香 Li Hong;Liu Jianjian;Wei Shumin;Xi Mujiao;Zhang Fazhan;Zong Shoukai;Chi Nana;Cao Qingxiang(Anesthesiology Operation Room,Dongying Hospital of Shandong Provincial Hospital Group,Dongying 257000,China;Department of Anesthesiology,Rizhao People's Hospital,Rizhao 276827,China;Department of Breast Surgery Rizhao People's Hospital,Rizhao 276827,China;Department of Neurology,Rizhao People's Hospital,Rizhao 276827,China)

机构地区：[1]山东省立医院集团东营医院,东营市人民医院麻醉科手术室,东营257000 [2]日照市人民医院麻醉科,日照276827 [3]日照市人民医院乳腺外科,日照276827 [4]日照市人民医院神经内科,日照276827

出　　处：《中华内分泌外科杂志》2024年第1期104-108,共5页Chinese Journal of Endocrine Surgery

基　　金：东营市科学技术局[东科成评字(2021)第068号]。

摘　　要：目的按探讨围手术期不同时间应用右美托咪定(dexmedetomidine,DEX)对乳腺癌根治术患者术后疼痛、氧化应激及不良反应的影响。方法前瞻性纳人2022年6月至2023年6月于东营市人民医院就诊并接受根治性手术治疗的90例乳腺癌患者作为研究对象,采用随机数字表法随机分为3组,每组各30例,分别于术前、术中、术后应用DEX组。记录术后疼痛视觉模拟评分(visual analogue scale,VAS)Rich-monation-镇静评分(Richmonation sedation score,RASS)、超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)的水平。结果术前、术中应用DEX组患者的苏醒时间分别为(16.16±2.01、18.32±1.68)min,拔管时间分别为(18.37±1.34、19.84±1.51)min,均显著低于术后应用DEX组的(20.26±1.9423.58±1.76)min,术前应用DEX组患者觉醒时间和拔管时间均显著低于术中应用DEX组(F=48.62、53.98,P均<0.001)。在术后1h、6h、12h时,术前、术中应用DEX组患者的VAS、RASS评分均显著低于术后应用DEX组,相较于术中应用DEX组的患者,术前应用DEX组患者的VAS、RASS评分均显著降低(F=62.34、55.24、69.26、36.82、24.20、39.97,P<0.001);术后24h时,VAS、RASS评分在3组患者中的比较差异无统计学意义(F=0.45、0.81,P=0.613、0.418)。在术毕即刻、术后24h、72h时,术前、术中应用DEX组患者的SOD水平均显著高于术后应用DEX组(F=29.37、33.24、10.35,P<0.001),MDA水平均显著低于术后应用DEX组(F=30.52、41.27、8.26,P<0.001)。术后不良反应发生率在各组患者中的比较差异无统计学意义(P>0.05)。结论术前和术中应用DEX可减轻乳腺癌患者术后疼痛和氧化应激反应,帮助患者术后快速恢复,且术前应用优于术中应用。Objective To explore the effects of dexmedetomidine(DEX)on postoperative pain,oxidative stress and adverse reactions in patients undergoing radical mastectomy.Methods A total of 90 patients with breast cancer who received radical surgical treatment in our hospital from Jun.2022 to Jun.2023 were prospective-ly included as research objects and randomly divided into 3 groups with 30 patients in each group.DEX group was applied before,during and after surgery,respectively.The levels of pain visual analogue scale(VAS),Richmona-tion sedation score(RASS),superoxide dismu-tase(SOD)and malondialdehyde(MDA)were recorded.Results The recovery time and extubation time in preoperative and intraoperative DEX group were significantly lower than those in postoperative DEX group,and the awakening time and extubation time in preoperative DEX group were significantly lower than those in intraoperative DEX group(F value was 48.62 and 53.98,respectively,P<0.001).At 1 h,6 h and 12 h after surgery,the VAS and RASS scores of patients in the preoperative and intraoperative DEX group were significantly lower than those in the postoperative DEX group,compared with those in the intraoperative DEX group.The VAS and RASS scores in the DEX group were significantly decreased(F value:62.34,55.24,69.26,36.82,24.20,39.97,P<0.001).At 24h after surgery,there was no significant difference in VAS and RASS scores among the three groups(F value was 0.45 and 0.81,respectively,P value was 0.613 and 0.418).Immediately after surgery,24 h after surgery,72 h after surgery,the SOD level of DEX group was significantly higher than that of DEX group before and during surgery(F value was 29.37,33.24,10.35,P<0.001).MDA levels were significantly lower than those in postoperative DEX group(F value was 30.52,41.27,8.26,P<0.001).There was no significant difference in the incidence of postoperative adverse reactions among all groups(P>0.05).Conclusion Preoperative and intraoperative application of DEX can reduce postoperative pain and oxidative stress in breast cancer pa

关 键 词：右美托咪定 乳腺癌改良根治术 疼痛 氧化应激 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]