右美托咪定硬膜外注射对肝癌切除术患者围术期麻醉质量的影响

摘要

目的 探讨右美托咪定硬膜外注射对肝癌切除术患者围术期麻醉质量的影响.方法 将拟行肝癌切除术患者60例,按照随机数字表法分为观察组和对照组,每组30例.观察组患者硬膜外注射右美托咪定0. 50 μg/kg,对照组注射等量生理盐水,两组麻醉诱导和维持方法相同.观察两组患者入室时(T1)、硬膜外穿刺即刻(T2)、诱导前(T3)、插管后(T4)、开腹后(T5)、肝门阻断即刻(T6)和拔管即刻(T7)的平均动脉压(MAP)、心率、中心静脉压(CVP).比较两组患者苏醒镇静评分、疼痛视觉模拟量表(VAS)评分、补救镇痛药用量、麻醉药用量.记录两组患者自主呼吸恢复时间、拔管时间、睁眼时间、苏醒时间、麻醉恢复室滞留时间和住院天数及术后不良反应发生率.结果 两组患者MAP、CVP均有随时间变化趋势(P＜0. 05),对照组MAP、CVP高于观察组(P＜0. 05),随着观察时间延长,两组心率均比较平稳(P＞0. 05),但对照组心率快于观察组(P＜0. 05);与对照组比较,观察组镇静评分增高,VAS评分降低,丙泊酚和舒芬太尼用量减少,术后自主呼吸恢复时间、睁眼时间和拔管时间缩短,并且苏醒期躁动、呛咳和恶心呕吐发生率降低(均P＜0. 05).结论 肝癌切除术患者硬膜外应用右美托咪定后血流动力学更稳定,镇静、镇痛效果更好,术后复苏平稳.%Objective To explore the effects of epidural administration of dexmedetomidine on quality of perioperative anesthesia in patients undergoing hepatectomy for hepatic carcinoma. Methods Sixty patients,scheduled for hepatectomy for hepatic carcinoma, were divided into observational group(n=30) and control group(n=30) using the random number table method. Patients in the observational group were given epidural dexmedetomidine(0. 50 μg/kg),while in the control group were given an equivalent volume of normal saline. Both groups receive the same anesthesia induction and maintenance approach. The mean blood pressure(MAP),heart rate and central venous pressure(CVP) were observed in the two groups at the following timepoints:admission( T1),right moment of epidural puncture (T2), before induction ( T3), after intubation ( T4), after abdominal opening ( T5), right moment of hepatic portal occlusion ( T6), and extubation immediately(T7). The sedation score,Visual Analogue Scale(VAS) score,dosage of analgesics supplement,and dosage of anesthetics were compared between the two groups. The durations for spontaneous breathing recovery,extubation,eye opening and awakening, post-anesthesia care unit stay,hospital stay,and incidence rate of postoperative adverse reactions were compared between the two groups. Results MAP and CVP changed over time in the two groups(P＜0. 05). MAP and CVP in the control group were higher than those in the observation group(P＜0. 05). Heart rate was stable in both groups with the increasing observation time(P＞0. 05),but heart rate in the control group was faster than that in the observation group(P ＜0. 05). Compared to the control group,the observation group achieved higher sedation score,lower VAS score,decreased dosages of propofol and sufentanil,less durations for postoperative spontaneous breathing recovery,eye opening and extubation,and lower incidence rates of emergence agitation,cough,nausea and vomiting(all P ＜0. 05). Conclusion Epidural administration of dexmedetomidine,applied to patients undergoing hepatectomy for hepatic carcinoma,might achieve more stable hemodynamics,preferable effects of sedation and analgesia,and favorable recovery after operation.