目的:探讨右美托咪定联合盐酸戊乙奎醚对腹腔镜手术全麻患者脑氧代谢、应激指标的影响。方法:将2022年1月～2023年1月张家口市第一医院收治的92例腹腔镜手术全麻患者根据随机数字表法分别纳入对照和试验组，每组各46例。对照组给予盐酸戊乙奎醚麻醉，试验组在此基础上给予右美托咪定麻醉，两组术后均随访3d。比较两组镇静效果，血流动力学指标，脑氧代谢、脑保护、应激指标及不良反应的发生情况。结果:术后30 min，试验组充分镇静率显著高于对照组(P＜0。05)。与麻醉诱导前比，两组手术60 min心率(HR)均降低，且试验组低于对照组(P＜0。05);与手术60 min比，两组手术结束时、术后30 min HR递增，试验组HR均低于对照组(P＜0。05)。与麻醉诱导前比，两组手术60 min平均动脉压(MAP)升高，试验组低于对照组(P＜0。05);与手术60 min比，两组手术结束时、术后30 min时MAP递减，且试验组MAP均低于对照组(P＜0。05)。与术前比，两组术后3d动脉-颈内静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)均降低，试验组低于对照组(P＜0。05);两组血清中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)、皮质醇(COR)、去甲肾上腺素(NE)、肾上腺素(AD)、丙二醛(MDA)水平升高，试验组低于对照组(P＜0。05);两组血清超氧化物歧化酶(SOD)水平降低，试验组高于对照组(P＜0。05)。随访期间，试验组不良反应总发生率低于对照组(P＜0。05)。结论:右美托咪定联合盐酸戊乙奎醚可有效减轻腹腔镜手术全麻患者应激反应，并可改善患者血流动力学及脑氧代谢，发挥脑保护作用，镇静效果较佳，安全性较高。
Effect of Dexmedetomidine Combined with Penehyclidine Hydrochloride on Laparoscopic Surgery
Objective:To investigate the effects of dexmedetomidine combined with penehyclidine hydrochloride on cerebral oxy-gen metabolism and stress index in patients undergoing laparoscopic surgery under general anesthesia.Methods:92 patients underwent laparoscopic surgery under general anesthesia in the First Hospital of Zhangjiakou City from January 2022 to January 2023 were randomly divided in the control and experimental group,with 46 cases in each group.The control group was anesthetized with pentylequidine hydrochloride,while the experimental group was anesthetized with dexmedetomidine on this basis.Both groups were followed up for 3 d after operation.The sedation effect,hemodynamic indexes,cerebral oxygen metabolism,cerebral protection,stress indexes,and occur-rence of adverse reactions were compared between the two groups.Results:At 30 min after operation,the adequate sedation rate of the experimental group was significantly higher than control(P＜0.05).The heart rate(HR)was lower in both groups at 60 min of surgery than those before induction of anesthesia,which was lower in the experimental group than that in the control group(P＜0.05);HR was in-cremented at the end of surgery and 30 min after surgery in both groups,and HR in the experimental group was lower than that in the control group(P＜0.05).The mean arterial pressure(MAP)at 60 min of surgery was elevated in both groups than those before induction of anesthesia,which was lower in the experimental group than that in the control group(P＜0.05);the MAP was decreasing at the end of the surgery and at 30 min after the surgery in both groups than those at 60 min of surgery,which was lower in the experimental group than that in the control group(P＜0.05).The arterial-internal jugular vein oxygen content difference(Da-jvO2)and cerebral oxygen uptake rate(CERO2)were lower in both groups at 3 d postoperatively than those in the preoperative period,which were lower in the experimen-tal group than in the control group(P＜0.05);the serum levels of central nervous system specific protein(S100β),neuron specific enolase(NSE),cortisol(COR),norepinephrine(NE),epinephrine(AD),malondialdehyde(MDA)in both groups were increased,which was lower in the experimental group(P＜0.05);the level of serum superoxide dismutase(SOD)in both groups were decreased,which was higher in the experimental group(P＜0.05).During the followed up,the adverse reaction rate of the experimental group was lower than the control(P＜0.05).Conclusion:Dexmedetomidine combined with pentylenetetrazol hydrochloride can effectively reduce the stress reaction of pa-tients undergoing general anesthesia for laparoscopic surgery,and improve the hemodynamics and cerebral oxygen metabolism with higher safety.
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