2019 年第 5 期 第 14 卷

右美托咪定复合全身麻醉对肝癌切除术患者麻醉效果和血流动力学的影响

Effect of dexmedetomidine combined with general anesthesia on anesthetic effect and hemodynamics in patients undergoing hepatectomy

作者：?罗超杨蓓刘晓鹏权哲峰池萍

英文作者：

单位：100069首都医科大学附属北京佑安医院麻醉科（罗超、刘晓鹏、权哲峰、池萍）；100029首都医科大学附属北京安贞医院麻醉中心（杨蓓）

英文单位：

关键词：肝癌切除术；右美托咪定；全身麻醉；血流动力学

英文关键词：

• 摘要：

• 【摘要】目的    探讨右美托咪定复合全身麻醉对肝癌切除术患者麻醉效果和血流动力学的影响。方法    选择2016年12月至2017年12月于首都医科大学附属北京佑安医院行择期全身麻醉下肝癌切除术患者60例，应用随机数字表法分为观察组和对照组，各30例。对照组患者于全身麻醉诱导前10 min静脉给予0.9%氯化钠注射液，观察组患者于全身麻醉诱导前10 min静脉给予右美托咪定。比较2组患者手术资料，麻醉诱导前10 min（T0）、诱导即刻（T1）、插管后5 min（T2）、拔管即刻（T3）、拔管后5 min（T4）、拔管后10 min（T5）、术后1 h（T6）、术后2 h（T7）的心率和平均动脉压，以及T4、T5、T6、T7时点静息状态下疼痛数字评分法评分及Ramsay镇静评分，术中麻醉药物用量和血管活性药物应用比例，术后并发症发生率及术后第1次肠排气时间。结果    对照组手术结束至气管导管拔出时间和麻醉恢复室停留时间均长于观察组［(16±8)min比（8±4）min，(36±12)min比（25±8）min］,差异均有统计学意义（均P＜0.05）。观察组T1、T3、T4、T5、T6时点心率和T1、T2、T4、T5、T6、T7时点平均动脉压均低于对照组，T4、T5、T6、T7时点静息状态下疼痛数字评分法评分和T4、T5时点Ramsay镇静评分均低于对照组，差异均有统计学意义（均P＜0.05）。观察组麻醉药物丙泊酚、瑞芬太尼、曲马多用量明显少于对照组［（889±149）mg比(1 229±254)mg，（3.1±0.4）mg比(4.8±0.9)mg，（55±9）mg比(88±13)mg］，乌拉地尔、艾司洛尔应用比例低于对照组［16.7%（5/30）比46.7%(16/30)，10.0%（3/30）比33.3%(10/30)］，但阿托品应用比例高于对照组［26.7%（8/30）比6.7%(2/30)］，差异均有统计学意义（均P＜0.05）。观察组术后第1次肠排气时间早于对照组［(48±7)h比（60±9）h］,差异有统计学意义（P＜0.05）。观察组术后恶心、呕吐、躁动、呛咳发生率均低于对照组，窦性心动过缓发生率高于对照组，差异均有统计学意义（均P＜0.05）。结论    右美托咪定复合全身麻醉对肝癌切除术患者围术期镇静、镇痛效果显著，可使血流动力学更稳定，镇痛、麻醉药物用量更少，患者麻醉恢复期更平稳，术后肠道功能恢复更快且并发症更少。

• 【Abstract】Objective    To observe the effect of dexmedetomidine on anesthetic effect and hemodynamics in patients undergoing hepatectomy with general anesthesia. Methods    Sixty patients undergoing elective hepatectomy for liver cancer from December 2016 to December 2017 in Beijing YouAn Hospital, Capital Medical University were randomly assigned into Dex group and Con group, with 30 cases in each group. The Con group was intravenously administrated 0.9% sodium chloride injection and the Dex group had dexmedetomidine 10 min before general anesthesia induction. Heart rate(HR) and mean arterial pressure(MAP) were monitored 10 min before induction(T0), during induction(T1), 5 min after intubation(T2), during extubation(T3), 5 min after extubation(T4), 10 min after extubation(T5), 1 h after operation(T6) and 2 h after operation(T7). Numerical Rating Scale(NRS) and Ramsay sedation score were assessed at T4, T5, T6 and T7. Dosage of anesthetics, use rate of vasoactive agents, incidence of postoperative complications and the first intestinal exhaust time were recorded. Results    Extubation time and post anesthesia care unit residence time in Dex group were shorter than those in Con group［(16±8)min vs（8±4）min， (36±12)min vs （25±8）min］(both P<0.05). HR at T1, T3, T4, T5, T6 time points and MAP at T1, T2, T4, T5, T6, T7 time points in Dex group were lower than those in Con group; NRS at T4, T5, T6, T7 and Ramsay sedation score at T4, T5 in Dex group were lower than those in Con group(all P<0.05). Consumptions of propofol, remifentanil and tramadol in Dex group were less than those in Con group［（889±149）mg vs (1 229±254)mg， （3.1±0.4）mg vs (4.8±0.9)mg， （55±9）mg vs (88±13)mg］(all P<0.05). Use rates of urapidil and esmolol in Dex group were lower and the use rate of atropine was higher than those in Con group ［16.7%（5/30） vs 46.7%(16/30)， 10.0%（3/30） vs 33.3%(10/30), 26.7%（8/30） vs 6.7%(2/30)］(all P<0.05). The first exhaust time in Dex group was earlier than that in Con group［(48±7)h vs （60±9）h］; incidences of nausea, vomiting, restlessness and cough were lower and the incidence of bradycardia was higher in Dex group than those in Con group(all P<0.05). Conclusion    Application of dexmedetomidine during general anesthesia can enhance the sedation and analgesia effects, stabilize hemodynamics, reduce the dosages of analgesic and narcotic drugs, promote postoperative intestinal function recovery and reduce complications.