摘要
目的 观察非离断Roux-en-Y式胃空肠吻合消化道重建术中应用右美托咪啶去阿片化平衡麻醉(OFA)的效果.方法 选取唐山职业技术学院附属医院2019年1月至2023年6月116例胃癌患者进行随机数字表法分组,58例纳入对照组(瑞芬太尼阿片化麻醉),58例纳入观察组(右美托咪啶OFA).比较两组麻醉不同时刻各项生命体征、术后不同时间疼痛程度、麻醉相关指标、预后情况、围手术期应激反应、不良反应及并发症发生情况.结果 观察组麻醉诱导后即刻、麻醉诱导后10 min、麻醉诱导后30 min、拔除喉罩时心率(HR)高于对照组,拔除喉罩时脑电双频指数(BIS)低于对照组,麻醉诱导后即刻、麻醉诱导后10 min、麻醉诱导后30 min平均动脉压(MAP)高于对照组(P＜0.05);术后2 h、4 h、8 h、12 h两组视觉模拟评分法(VAS)评分比较差异无统计学意义(P＞0.05);观察组拔管时间、定向力恢复时间短于对照组(P＜0.05);两组术后24 h内镇痛泵(PCA)平均按压次数、术后至首次按压PCA时间比较差异无统计学意义(P＞0.05);两组首次下床时间、首次排气时间、住院时间比较差异无统计学意义(P＞0.05);围手术期两组皮质醇、肾上腺素、空腹血糖比较差异无统计学意义(P＞0.05);观察组恶心呕吐发生率、不良反应总发生率低于对照组(P＜0.05).结论 非离断Roux-en-Y式胃空肠吻合消化道重建术中使用右美托咪啶OFA麻醉安全性高,镇痛效果良好,术中患者生命体征更稳定,可减少不良反应和并发症发生率,不影响患者预后效果.
Abstract
Objective To observe the effect of dexmedetomidine deopioid balanced anesthesia(OFA)in Roux-en-Y gastrojejunal anastomosis reconstruction of digestive tract.Methods A total of 116 patients with gastric cancer in Tan-gshan Vocational and Technical College Affiliated hospital from January 2019 to June 2023 were selected for random number table grouping,58 cases were included in the control group(remifentanil opioid anesthesia),and 58 cases were included in the observation group(dexmedetomidine OFA).Various vital signs at different time of anesthesia,pain de-gree at different time after surgery,anesthesia related indexes,prognosis,perioperative stress reaction,adverse reactions and complications were compared between the two groups.Results The heart rate(HR)of the observation group was higher than that of the control group immediately after anesthesia induction,10 min after anesthesia induction,30 min after anesthesia induction,and the bifrequency index(BIS)of the brain was lower than that of the control group.The mean arterial pressure(MAP)immediately after anesthesia induction,10 min after anesthesia induction and 30 min after anesthesia induction was higher than that of control group(P＜0.05).There was no significant difference in visual ana-logue scale(VAS)scores between the two groups at 2 h,4 h,8 h and 12 h after surgery(P＞0.05).The extubation time and orientation recovery time of observation group were shorter than those of control group(P＜0.05).There were no significant differences between the two groups in the average number of PCA compressions within 24 h after surgery and the time from the first PCA compressions after surgery(P＞0.05).There were no significant differences in the first time of getting out of bed,the first time of exhaust and the time of hospitalization between the two groups(P＞0.05).There were no significant differences in cortisol,epinephrine and fasting blood glucose between the two groups during perioperative period(P＞0.05).The incidence of nausea and vomiting and the total incidence of adverse reactions in the observation group were lower than those in the control group(P＜0.05).Conclusion Dexmedetomidine OFA anesthe-sia used in Roux-en-Y gastrojejunal anastomosis digestive tract reconstruction has high safety,good analgesic effect,more stable vital signs of patients during the operation,can reduce the incidence of adverse reactions and complications,and does not affect the prognosis of patients.
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