| 摘要: |
| 目的:探讨全麻复合右美托咪啶与全麻联合硬膜外阻滞对老年腹腔镜下结直肠癌根治术患者应激反应及术后恢复情况的影响。方法:选择择期行腹腔镜下结直肠癌根治术老年患者60 例，年龄≥ 65 岁，ASA Ⅰ或Ⅱ级，随机分为两组，全麻复合右美托咪啶组(D 组)和全麻联合硬膜外阻滞组(E 组)，每组30 例:D 组在麻醉诱导前10 min 静脉泵注右美托咪啶0.8 μg/kg，气管插管后以0.5 μg/(kg · h) 的速度静脉泵注右美托咪啶，术毕前30 min 停药；E 组给予硬膜外阻滞，将平面固定在T4 行全麻插管，术中间断硬膜外给药。记录两组患者术中全麻药物的用量；分别于诱导前(T0)、气管插管后即刻(T1)、气腹后5 min(T2)、气腹后30 min(T3)、拔管后即刻(T4)抽取静脉血，测定血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)浓度以及血糖的浓度；记录两组患者术后1、6、12、24、48 h 的VAS 评分，以及排气时间、进食时间和住院时间。结果:T2、T3时D组的心率明显慢于E组(P <0.05) ；T2、T3时D组的心率与T0相比明显减慢(P <0.05)。在T1、T2 时间点，D 组E、NE、Cor 浓度低于E 组(P <0.05)；在T0、T3、T4 时间点，D 组与E 组的E、NE、Cor 浓度差异无统计学意义(P >0.05)；D 组患者术后VAS 评分、术后排气时间、进食时间和住院时间差异无统计学意义(P >0.05)。结论:全麻复合右美托咪啶可以有效减轻老年腹腔镜结直肠癌根治术患者围术期的应激反应，其效果优于联合硬膜外阻滞。 |
| 关键词: 右美托咪啶 硬膜外麻醉 全身麻醉 应激反应 腹腔镜 结直肠癌 |
| DOI：10.3969/j.issn.1007-6948.2020.03.009 |
| 投稿时间：2019-10-18 |
| 基金项目:2016 年河北省政府资助临床医学优秀人才培养和基础课题研究项目基金资助(361036) |
|
| Application of Dexmedetomidine and Epidural Block in Laparoscopic Radical Resection of ColorectalCancer in Elderly Patients under General Anesthesia |
| GAO Yu-ting,ZHANG Shu-bo,GAO Xiao-zeng |
| Department of Anesthesia, North China University of Science and Technology Affiliated Hospital, Tangshan063000, China |
| Abstract: |
| Objective To compare the effects of dexmedetomidin combined general anesthesia and epidural combined general anesthesia on the stress response and postoperative recovery of elderly patients with laparoscopic radical resection of colorectal cancer. Methods A total of 60 elderly patients with colorectal cancer undergoing laparoscopic surgery were selected, with age 65 or older, ASA grade I or II. It was randomly divided into two groups, with 30 cases in each group. Group D was induced by 10 min intravenous infusion of dexmedetomidine 0.8 μg/kg before anesthesia induction. After intubation, right metodetomidine was injected to 0.5 μg/(kg · h) to the preoperative 30 min, and the patients in group E were fixed on T4. The dosage of narcotic drugs was recorded during the operation (T0), immediately after endotracheal intubation (T1), 5 min (T2) after pneumoperitoneum (T2), 30 min (T3) after pneumoperitoneum (T3), and immediately after extubation (T4) to determine the concentration of E, NE, Cor and GLU. The VAS score of the patients 1 h, 6 h,12 h, 24 h and 48 h after surgery, postoperative exhaust time, eating time, hospital stay and related complications were recorded. Results At T2 and T3, the heart rate of group D was significantly slower than that of group E (P <0.05). At T2 and T3, the heart rate of group D was significantly slower than that of T0 (P <0.05).The concentration of E, NE and Cor in group D at time points T1 and T2 was lower than that in group E(P <0.05). There was no significant difference in |
| Key words: Dexmedetomidine epidural anesthesia general anesthesia stress response laparoscope colorectal cancer |
