右美托咪定对胃癌根治术患者应激反应及术后凝血功能的影响
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摘要
目的:探讨右美托咪定对胃癌根治术患者应激反应及术后凝血功能的影响。方法:选择本院2015年1月至2017年12月收治的82例胃癌患者,按随机数字表法分为对照组和研究组,每组41例。对照组在常规麻醉基础上加以生理盐水麻醉,研究组在常规麻醉基础上加以右美托咪定麻醉,比较两组瑞芬太尼及丙泊酚用量、血流动力学、应激反应、凝血功能、不良反应发生情况。结果:研究组瑞芬太尼及丙泊酚用量少于对照组,差异有统计学意义(P<0.05)。两组术后心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、呼吸频率(HR)均上升,但研究组低于对照组(P<0.05)。两组术后皮质醇、血糖、C反应蛋白(CRP)及白细胞介素-6(IL-6)均上升,但研究组上升幅度较小,差异有统计学意义(P<0.05)。两组纤维蛋白原(FIB)、凝血酶原时间(PT)、血栓素B2(TXB2)水平均上升,但研究组低于对照组(P<0.05)。两组术后均有躁动、恶心呕吐、心动过速发生,但差异无统计学意义(P>0.05)。结论:右美托咪定能够减轻胃癌根治术患者的应激反应,对凝血功能的影响较小,有利于术后患者的恢复,建议作为有效的全麻辅助用药。
Objective:To explore the effect of dexmedetomidine on stress response and postoperative coagulation function in patients with radical gastrectomy.Methods:A total of 82 patients with gastric cancer treated in our hospital from January 2015 to December 2017 were selected and randomly divided into a control group and a study group,with 41 cases in each group.The patients in the control group received conventional anesthesia,and those in the study group received conventional anesthesia combined with dexmedetomidine.The remifentanil and propofol dosage,hemodynamic change,stress response,coagulation function,and the incidence of adverse reactions were observed and compared.Results:Remifentanil and propofol dosage in the study group was lower than that in the control group(P<0.05).After operation,the heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP)and respiratory rate(HR),and the levels of cortisol,blood glucose,C-reactive protein(CRP),interleukin-6(IL-6),fibrinogen(FIB)and thrombin B2(TXB2)as well as prothrombin time(PT)in both group were increased,but these changes were unconspicuous in the study group when compared with the control group(P <0.05).Conclusion:Dexmedetomidine could reduce the stress response of patients who underwent radical gastrectomy.It had less impact on coagulation function and promoted the recovery of patients.
Objective:To explore the effect of dexmedetomidine on stress response and postoperative coagulation function in patients with radical gastrectomy.Methods:A total of 82 patients with gastric cancer treated in our hospital from January 2015 to December 2017 were selected and randomly divided into a control group and a study group,with 41 cases in each group.The patients in the control group received conventional anesthesia,and those in the study group received conventional anesthesia combined with dexmedetomidine.The remifentanil and propofol dosage,hemodynamic change,stress response,coagulation function,and the incidence of adverse reactions were observed and compared.Results:Remifentanil and propofol dosage in the study group was lower than that in the control group(P<0.05).After operation,the heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP)and respiratory rate(HR),and the levels of cortisol,blood glucose,C-reactive protein(CRP),interleukin-6(IL-6),fibrinogen(FIB)and thrombin B2(TXB2)as well as prothrombin time(PT)in both group were increased,but these changes were unconspicuous in the study group when compared with the control group(P <0.05).Conclusion:Dexmedetomidine could reduce the stress response of patients who underwent radical gastrectomy.It had less impact on coagulation function and promoted the recovery of patients.
引文
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[11]王红仙,张野,李云,等.右美托咪定对胃癌根治术中瑞芬太尼复合丙泊酚全麻药量及麻醉效果的影响[J].安徽医科大学学报,2014,49(1):88-91.
[12]欧阳文博,刘东辉.胃癌根治术中瑞芬太尼复合丙泊酚应用右美托咪定对全麻药量及麻醉效果的影响[J].实用癌症杂志,2015,30(6):925-928.
[13]楼纪萍,欧阳碧山.右美托咪定复合依托咪酯麻醉对于胃癌根治术患者术后疼痛与感染的影响[J].中国药物与临床,2015,15(10):1392-1395.
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[15]汪亚宏,吕志勇,王忠慧,等.右美托咪定辅助全身麻醉对胃癌根治术患者围麻醉期血流动力学、麻醉药用量及术后镇静镇痛的影响[J].实用临床医药杂志,2017,21(11):87-89.
[16]赵正兰,方琴,王炎林.右美托咪定对腹腔镜下胃癌手术七氟醚用量以及血清学指标的影响[J].海南医学院学报,2015,21(3):390-392.
[17]张锦萍,冯涛,王洪强.右美托咪啶在老年腹腔镜胃癌根治术中的作用[J].中国中西医结合外科杂志,2017,23(4):362-365.
[18]张静贻.右美托咪定对老年胃癌患者围术期IL-1β、IL-6、TNF-α及CRP的影响及作用机制探讨[J].标记免疫分析与临床,2016,23(8):878-880.
[19]钱晓岚,王庆端,张卫,等.右美托咪定对术后老龄小鼠海马组织白介素1β和肿瘤坏死因子α表达的影响[J].上海交通大学学报(医学版),2015,35(2):184-188.
[20]陈正,邵东华,毛祖旻,等.右美托咪定对胃癌根治术后凝血功能的影响[J].临床麻醉学杂志,2017,33(11):1086-1090.
[2]蒙丽宇.右美托咪定对腹腔镜手术患者应激及炎性反应的影响[J].中国医药导报,2015,12(13):112-116.
[3]孙怡,岳生,黄晓晨,等.不同剂量右美托咪定对腹腔镜下胃肠手术老年患者围术期应激反应的影响[J].临床麻醉学杂志,2017,33(11):1061-1065.
[4]毕艳,李涓,侯正友.两种麻醉方式对腹腔镜胃癌根治术CO2气腹对患者血气及应激水平的影响[J].标记免疫分析与临床,2015,22(11):1104-1106.
[5]于铁莉,岳文慧,王金城,等.右美托咪定在胃癌根治术中的临床应用研究[J].河北医学,2014,20(12):2006-2009.
[6]中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[J].中国医学前沿杂志(电子版),2013,5(8):29-36.
[7] WANG C,WANG G,SU Z,et al.Laparoscopy-assisted D2radical gastrectomy for advanced gastric cancer[J].Hepatogastroenterology,2015,62(139):758-761.
[8] YAMAMOTO M,ZAIMA M,YAMAMOTO H,et al.Laparoscopictotal gastrectomy for remnant gastric cancer following distal gastrectomy with radical lymphadenectomy[J]. Hepatogastroenterology, 2015,62(139):752-757.
[9] KANDA M,FUJIWARA M,TANAKA C,et al.Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic(assisted)distal gastrectomy[J].Surg Endosc,2016,30(10):4353-4362.
[10]NAKAUCHI M,SUDA K,KADOYA S,et al.Technical aspects and short-and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer:a single-institution retrospective study[J].Surg Endosc,2016,30(10):4632-4639.
[11]王红仙,张野,李云,等.右美托咪定对胃癌根治术中瑞芬太尼复合丙泊酚全麻药量及麻醉效果的影响[J].安徽医科大学学报,2014,49(1):88-91.
[12]欧阳文博,刘东辉.胃癌根治术中瑞芬太尼复合丙泊酚应用右美托咪定对全麻药量及麻醉效果的影响[J].实用癌症杂志,2015,30(6):925-928.
[13]楼纪萍,欧阳碧山.右美托咪定复合依托咪酯麻醉对于胃癌根治术患者术后疼痛与感染的影响[J].中国药物与临床,2015,15(10):1392-1395.
[14]HAVERKAMP L,RUURDA J P,OFFERHAUS G J,et al.Laparoscopic gastrectomy in western European patients with advanced gastric cancer[J].Eur J Surg Oncol,2016,42(1):110-115.
[15]汪亚宏,吕志勇,王忠慧,等.右美托咪定辅助全身麻醉对胃癌根治术患者围麻醉期血流动力学、麻醉药用量及术后镇静镇痛的影响[J].实用临床医药杂志,2017,21(11):87-89.
[16]赵正兰,方琴,王炎林.右美托咪定对腹腔镜下胃癌手术七氟醚用量以及血清学指标的影响[J].海南医学院学报,2015,21(3):390-392.
[17]张锦萍,冯涛,王洪强.右美托咪啶在老年腹腔镜胃癌根治术中的作用[J].中国中西医结合外科杂志,2017,23(4):362-365.
[18]张静贻.右美托咪定对老年胃癌患者围术期IL-1β、IL-6、TNF-α及CRP的影响及作用机制探讨[J].标记免疫分析与临床,2016,23(8):878-880.
[19]钱晓岚,王庆端,张卫,等.右美托咪定对术后老龄小鼠海马组织白介素1β和肿瘤坏死因子α表达的影响[J].上海交通大学学报(医学版),2015,35(2):184-188.
[20]陈正,邵东华,毛祖旻,等.右美托咪定对胃癌根治术后凝血功能的影响[J].临床麻醉学杂志,2017,33(11):1086-1090.