| 贺峰.右美托咪定对轻度肝功异常者胃癌根治术应激反应的影响[J].安徽医药,2016,20(1):175-178. |
| 右美托咪定对轻度肝功异常者胃癌根治术应激反应的影响 |
| Effects of dexmedetomidine on stress response of patients with mild liver dysfunction undergoing radical gastrectomy |
| 投稿时间：2015-07-24 |
| DOI： |
| 中文关键词: 轻度肝功异常 右美托咪定 全麻 胃癌根治术 应激反应 |
| 英文关键词: mild liver dysfunction dexmedetomidine anesthesia radical gastrectomy stress response |
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| 中文摘要: |
| 目的 探讨不同剂量右美托咪定对轻度肝功异常患者全麻下胃癌根治术应激反应的影响。方法 选取2011年2月至2013年3月在该院行开腹胃癌根治术患者81例,肝功能Child-Pugh分级A级,随机分为对照组(n=27)、低剂量组(n=27)和高剂量组(n=27),低剂量组和高剂量组分别将负荷量0.4 μg·kg-1和0.8 μg·kg-1右美托咪定静脉输注,随后以0.2 μg·kg-1·h-1和0.4 μg·kg-1·h-1静输至手术结束前30 min；对照组采用相同的方法静输等容量生理盐水。分别于不同时点,对血浆中肾上腺素和去甲肾上腺素浓度,以及血清IL-6和C-反应蛋白浓度进行检测。结果 低剂量组和高剂量组患者异丙酚用量均少于对照组(P<0.05)；与T0相比,三组患者T1-4时刻E、NE、IL-6和CRP浓度均出现了升高(P<0.05)；与对照组相比,低剂量组和高剂量组患者T1-4时刻E、NE、IL-6和CRP浓度均低于对照组(P<0.05)；高剂量组患者苏醒时间(40.2±12.3)min,长于对照组和低剂量组(P<0.05)；高剂量组和低剂量组患者麻醉恢复期躁动发生率均低于对照组(P<0.05),高剂量组总并发症发生率33.3%,高于低剂量组,差异具有统计学意义(P<0.05),对照组患者术后认知功能障碍发生率29.6%,远高于低剂量组和高剂量组,差异均具有统计学意义(P<0.05)。结论 右美托咪定可以有效缓解轻度肝功异常患者全麻下胃癌根治术应激反应,减少麻醉恢复期躁动发生,其中,低剂量给药方式效果更佳,建议临床使用。 |
| 英文摘要: |
| Objective To investigate the effects of different doses of dexmedetomidine on stress response of general anesthesia surgery for gastric cancer in patients with mild liver dysfunction. Methods We selected81 cases of patients undergoing open radical gastrectomy in Second Hospital of Yulin City from February 2011 to March 2013, whose liver functions were in class Aaccording to Child-Pugh classification. All cases were randomized into control group (n=27), low dose group (n=27) and high dose group (n=27). Patients in low dose group and high dose group were given 0.4 μg·kg-1 and 0.8 μg·kg-1 dexmedetomidine intravenous infusion, respectively, followed by 0.2 μg·kg-1 · h-1 and 0.4 μg·kg-1· h-1 intravenous infusion 30 min before the end of surgery. Patients in the control group were given the same amount of saline with the same method. At different time points, the concentrations of epinephrine, norepinephrine, IL-6 and C-reactive protein were detected. Results The volumes of propofol in low dose group and high dose group were lower than the control group (P<0.05). Compared with T0, the concentrations of E, NE, IL-6 and CRP were all increased at T1-4 moments (all P<0.05). Compared with the control group, the concentrations of E, NE, IL-6 and CRP in low dose group and high dose group were lower than the control group (all P<0.05). The awake time of high dose group was (40.2 ± 12.3)min, which was longer than the control group and low dose group (all P<0.05). The incidences of agitation during recovering of anesthesia in the high dose group and low dose group were lower than the control group (all P<0.05). The total complication incidence in the high dose group was 33.3%, which was higher than the low dose group with significant difference (P<0.05). The incidence of cognitive dysfunction in the control group was 29.6%, which was higher than the low dose group and high dose group with significant difference (P<0.05). Conclusion Dexmedetomidine could effectively relieve the stress response of general anesthesia surgery for gastric cancer in patients with mild liver dysfunction, and reduce the occurrence of restlessness during recovery of anesthesia. Among them, the effect of low dose administration was better, which was recommended for clinical use. |
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