右美托咪定辅助全身麻醉在胃癌根治术中的应用价值.docx
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1、右美托咪定辅助全身麻醉在胃癌根治术中的应用价值蒋敢,常江*武警陕西省总队医院麻醉科,陕西西安710054通讯作者:常江()摘要:目的:探讨胃癌根治术中右美托咪定辅助全身麻醉对患者围术期血流动力学、免疫和 炎性因子的影响。方法:选择武警陕西省总队医院2017年2月至2019年6月收治的98例 拟行胃癌根治术患者为研究对象,根据随机数字表法分为对照组和观察组,每组49例。对 照组采用全身麻醉,观察组采用右美托咪定辅助全身麻醉。记录并比较两组患者围术期的心 率(HR)、平均动脉压(MAP)、呼吸(RR)、血氧饱和度(SpO2);检测并比较两组患者围 术期的T淋巴细胞(CD3+、CD4+、CD8+)水
2、平;检测并比较两组患者围术期的白介素6(山6)、 白介素-10 (IL-10)、白介素-1。(IL-10);采用Ramsay镇静评分、视觉模拟量表(VAS)正 价两组患者的镇静和镇痛效果。结果:观察组患者麻醉诱导前(TI)、切皮时(T2)、手术 结束时(T3)、苏醒时(T4)的HR、RR、SpCh与对照组比较差异均无统计学意义(P0.05), 但观察组患者的MAP)明显高于对照组,差异有统计学意义(PV0.05);观察组患者T1-T4 时的CD3+、CD4+、CD8+水平明显高于对照组,血清IL-6、IL-10、IL-1 B水平明显低于对 照组,差异均有统计学意义(PV0.05);观察组患者苏
3、醒30min-3h时的视觉模拟评分(VAS) 明显低于对照组,差异均有统计学意义(PVQ05)。结论:右美托咪定辅助全身麻醉有助于 稳定胃癌根治手术患者围术期血流动力学稳定,降低血清炎性细胞因子水平,保护免疫功能, 并具有显著的镇静镇痛效果。关键词:胃癌;右美托咪定;全身麻醉;血流动力学;免疫;炎性反应The value of dexmedetomidine assisted general anesthesia in radical gastrectomyJiang Gan, Chang Jiang *Department of Anesthesiology, Shaanxi Provinc
4、ial Corps Hospital, Xian 710054Abstract: Objective: To investigate the effect of dexmedetomidine assisted general anesthesia on perioperative hemodynamics, immunity and inflammatory factors in patients with gastric cancer. Methods: 98 palienls wilh gaslric cancer undergoing radical gaslrectomy in Sh
5、aanxi Provincial Armed Police Corps Hospital from February 2017 to June 2019 were selected as the research objects, and (hey were randomly divided inlo control group and observation group, wilh 49 cases in each group. The conlrol group was given gcncial ancslhesia, and Ihe obscrvalion group was give
6、n dexmedetomidine assisled general anesthesia. The perioperalive hearl rate (HR), meanarterial pressure (map), respiration (RR) and blood oxygen saturation (SpO2) of the two groups were recorded and compaied; the levels of T lymphocytes (CD3 +, CD4 +, CD8 +) in the two groups were detected and compa
7、red; the perioperative levels of interleukin6 (IL-6), interleukin10interleukinl (3 (IL-1 |3) were detected and compared between the twogroups: Ramsay was used for sedation The sedative and analgesic effects were evaluated by visual analogue scale (VAS). Results: The HR、RR and SpO2 of Ihc observalion
8、 group before aneslhcsia induction (Tl), skin incision (T2), end of operation (T3) and lecovery (T4) had no statistical significance (P0.05), but the map of the observation group was significantly higher than that of the conlrol group、the difference was statistically significant (P 0.05): the levels
9、 of CD3 +、CD4 +, CD8 + al Tl4 in ihe observation group were significanlly higher Ihan ihose in he control group, and Ihc scrum IL-6 and IL-10 were significantly higher in ihc observalion group The levels of IL-1 (3 and IL-1 0 in the observation group were significantly lower than those in the contro
10、l group (P v 0.05); the visual analogue scale (VAS) in the observation group was significantly lower than that in the control group (P 0.05),具有可 比性。本研究经医院医学伦理委员会批准,患者及家属均知情并签署同意书。1.2 麻醉方法术前常规禁饮禁食,入室后面罩吸氧3L/min,开放静脉通路,多功能心电 监护仪监测收缩压、舒张压、心率、呼吸频率、平均动脉压脉搏血氧饱和度,麻醉深度检测 仪监测脑电双频指数(BIS)指数。121对照组l 麻醉诱导:静脉注射瑞芬
11、太尼0.05|ig/kg、丙泊酚lmg/kg麻醉诱导,睫毛反射消失置入喉罩,连接呼吸机机械通气(潮气量8-10ml/kg,通气频率12次/min、吸呼比: 1:2),瑞芬太尼OZiig/kg/min-丙泊酚4-8mg/kg/h维持麻醉,保证血流动力学平稳,麻醉深 度登以&指数维持在45-55之间。L2X观察组在对照组基础上增加右美托咪定,诱导麻醉前静脉泵注盐酸右美托咪定注射 液(江苏恩华药业股份有限公司,国药准字H ) 0.6pg/ kg 15 min,调至0.4pg/(kg-h)维持至 术毕前4() min。麻醉诱导和维持同对照组。术中应用阿托品/艾司洛尔控制患者心率在50-90 次/分,麻
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