盐酸右美托咪啶对老年腹腔镜结直肠癌根治术患者拔管期心血管反应的影响

摘要

目的 观察盐酸右美托咪啶对老年腹腔镜结直肠癌根治术患者拔管期心血管反应的影响.方法 纳入90例接受结直肠癌根治术的患者作为研究对象,随机分为三组,每组各30例.A、B、C三组在手术结束前10 min分别静脉输注0.3 μg/kg、0.5 μg/kg及0.7 μg/kg右美托咪啶,记录三组人室时(T1)、用药时(T2)、拔管时(T3)、拔管后10 min (T4)及拔管后30 min(T5)时平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO2)水平,比较三组麻醉苏醒质量及麻醉安全性.结果 B、C两组T3、T4及T5时MAP和HR均显著低于A组(均P＜ 0.05),B、C两组间T3、T4及T5时MAP和HR无显著性差异(均P＞0.05),三组SpO2各时间点无显著性差异(均P＞ 0.05).三组患者睁眼时间、呼吸恢复时间及拔管时间无显著性差异(均P＞0.05),C组苏醒时间显著长于A组(P＜0.05).C组躁动严重程度显著轻于A组(P＜0.05),恶心呕吐发生率显著高于A组(P＜0.05),B、C两组躁动、恶心呕吐发生率及三组呛咳、寒战及心动过速发生率均无显著性差异(均P＞ 0.05).结论 右美托嘧啶用于结直肠癌根治术老年患者有助于维持围拔管期血流动力学稳定,中等剂量较低剂量效果更为显著,能减轻心血管反应,且具有较高的安全性.%Objective To study the effect of dexmedetomidine on cardiovascular response during extubation in older patients undergoing laparoscopic radical resection of colorectal cancer.Methods 90 patients underwent radical resection for colorectal cancer were randomly assigned to three groups,with 30 cases in each group.A,B and C three groups received intravenous infusion of 0.3 μtg/kg,0.5 μg/kg,and 0.7 μg/kg dexmedetomidine,respectively,10min before the end of surgery.The mean arterial pressure (MAP),heart rate (HR) and blood oxygen saturation (SpO2) were recorded the time to enter the operation room (T1),medication (T2),extubation (T3),10min after extubation (T4) and 30minafier extubation (T5).The quality of anesthesia recovery and safety of anesthesia were compared between the three groups.Results The MAP and HR at T3,T4 and T5 in group B and C were significantly lower than those in group A (P ＜ 0.05).There was no significant difference in MAP and HR at T3,T4 and T5 between group B and C (P ＞ 0.05).There was no significant difference among the three groups in SpO2 at each time point (P ＞ 0.05).There was no significant difference in the time to eye opening,time to respiratory recovery and time to extubation among the three groups (P ＞ 0.05).The recovery time in group C was significantly longer than that in group A (P ＜ 0.05).The severity of agitation in group C was significantly less than that in group A (P ＜ 0.05).The incidence of nausea and vomiting was significantly higher than that in group A (P ＜ 0.05).There were no significant difference in the incidence of restlessness,nausea and vomiting between group B and C and the incidence of cough,chills and sychnosphygmia did not differ among the three group (P ＞ 0.05).Conclusion The dexmedetomidine can improve hemodynamics during the extubation period in patients undergoing radical resection of colorectal cancer.The moderate dosage were more effective than lower dosage.It can reduce the cardiovascular reaction and has high security.