右美托咪定静脉自控镇痛联合静吸复合麻醉用于胃癌患者麻醉中的临床观察  

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

作　　者：王敏 陈琴[1] 项云[1] Min Wang;Qin Chen;Yun Xiang(Department of Anesthesio-logy,Lishui People’s Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市人民医院麻醉科,浙江省丽水市323000

出　　处：《世界华人消化杂志》2025年第1期53-61,共9页World Chinese Journal of Digestology

摘　　要：背景腹腔镜胃癌根治术在胃癌治疗中应用广泛,但患者术后多伴中重度疼痛.以往术后镇痛多依赖阿片类药物,其不良反应明显,且全麻易诱发认知功能障碍.联合右美托咪定可增强镇痛效应、减少认知功能损害,有利于促进预后恢复.目的探讨右美托咪定静脉自控镇痛(patient controlled intravenousanalgesia,PCIA)联合静吸复合麻醉对胃癌患者术后48 h麻醉药物使用情况及早期认知功能的影响.方法选取2021-05/2024-03于我院择期拟行腹腔镜胃癌根治术的胃癌患者206例,按随机数字表法分为对照组(n=103)、研究组(n=103).两组术后均行PCIA,对照组泵注枸橼酸舒芬太尼、盐酸托烷司琼,研究组泵注枸橼酸舒芬太尼、盐酸托烷司琼、右美托咪定.比较两组术后不同时间点平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(oxygen saturation,SpO2)、镇痛评分[视觉模拟量表(visual analogue scale,VAS)评分]、镇静评分[拉姆齐(Ramsay)镇静评分]、早期认知功能[蒙特利尔认知评估量表(Montreal Cognitive Assessment Scale,MoCA)评分、简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)评分]、血清相关因子[白介素-6(interleukin 6,IL-6)、高迁移率族蛋白B1(high mobility group box 1 protein,HMGB1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]及术后48 h麻醉药物使用情况、不良反应发生率.结果研究组术后2 h-48 h MAP、HR低于对照组,差异有统计学意义(P<0.05);研究组术后12 h-48 h VAS评分低于对照组,MMSE、MoCA评分高于对照组,差异有统计学意义(P<0.05);研究组术后24 h、48 h IL-6、TNF-α、HMGB1低于对照组,差异有统计学意义(P<0.05);研究组术后48 h内PCIA按压次数低于对照组,差异有统计学意义(P<0.05);两组术后2 h-48 h SpO2,术后2 h-48 hRamsay评分及不良反应发生率比较,差异无统计学意义.结论右美托咪定PCIA联合静吸复合麻醉可有效缓解胃�BACKGROUND Laparoscopic radical gastrectomy is widely used in the treatment of gastric cancer,but patients often experience moderate to severe pain after surgery.In the past,postope-rative analgesia mostly relied on opioids,which have significant adverse reactions and easily induce cognitive dysfunction during general anesthesia.When combined with dexmedetomidine,they can enhance analgesic effect,reduce cognitive impairment,and promote patient recovery.AIM To investigate the effects of dexmedetomidine patient-controlled intravenous analgesia(PCIA)with dexmedeto-midine in combination with inhalation-intravenous combined anesthesia on early cognitive function in patients with gastric cancer undergoing laparoscopic radical gastrectomy.METHODS A total of 206 patients with gastric cancer who were scheduled to undergo laparoscopic radical gastrectomy in our hospital from May 2021 to March 2024 were selected.They were divided into a control group(n=103)and a study group(n=103)using the random number table method.Both groups underwent PCIA after surgery.The control group additionally received pump injections of sufentanil citrate and tropisetron hydrochloride,while the study group additionally received pump injections of sufentanil citrate,tropisetron hydrochloride,and dexmedetomidine.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2),analgesia score[visual analog scale(VAS)score],sedation score[Ramsay sedation scale],early cognitive function[Montreal Cognitive Assessment Scale(MoCA)score and mini-mental state examination(MMSE)score],and serum factors[interleukin-6(IL-6),high mobility group box 1 protein(HMGB1),and tumor necrosis factor-α(TNF-α)]at different time points after surgery,as well as anesthesia drug use within 48 hours after surgery and adverse reaction rate,were compared between the two groups.RESULTS The MAP and HR of the study group were significantly lower than those of the control group from 2 to 48 hours after surgery(P<0.05).The VAS scores of the study group were significantl

关 键 词：胃癌 右美托咪定 静脉自控镇痛 镇静效果 认知功能 

分 类 号：R614[医药卫生—麻醉学]