摘要
探讨全麻复合右美托咪定与复合硬膜外麻醉对手术患者应激反应、血液流动力学、术后恢复等的影响.方法 将192例经腹行胃癌根治术治疗的患者按随机数字表法分为3组,右美托咪定组复合全麻,硬膜外麻醉组复合全麻,常规组实施全麻,各64例.比较3组麻醉不同时间点心率、平均动脉压、血清应激反应指标水平变化情况,比较3组视觉模拟评分法评分、术后恢复情况及不良反应发生情况.结果 全麻诱导前—拔管后即刻3组心率及平均动脉压波动幅度比较差异有统计学意义(P<0 .05或0 .01) .气管插管后即刻、切皮时、拔管后即刻3组去甲肾上腺素、肾上腺素水平比较差异有统计学意义(P<0 .01) ,切皮时、拔管后即刻3组皮质醇水平比较差异有统计学意义(P<0 .01) ,气管插管后即刻、切皮时、拔管后即刻右美托咪定组与硬膜外组去甲肾上腺素、肾上腺素、皮质醇水平比较差异无统计学意义(P>0 .05) .术后3组视觉模拟评分法评分比较差异有统计学意义(P<0 .01) ,右美托咪定组与硬膜外组评分比较差异无统计学意义(P>0 .05) . 3组术后恢复时间比较差异有统计学意义(P<0 .01) ,不良反应发生率比较差异有统计学意义(P<0 .01) .结论 全麻复合右美托咪定与全麻复合硬膜外麻醉均可抑制手术患者的应激反应,保持血液流动力学指标稳定,缩短术后恢复时间,改善术后镇痛效果.
Objective To investigate the effects of general anesthesia combined with dexmedetomidine and epidural anesthesia on stress response , hemodynamics and postoperative recovery in surgical patients. Methods 192 patients who underwent radical gastrectomy for gastric cancer were randomly divided into 3 groups according to the random number table method ,the dexmedetomidine group combined with general anesthesia ,epidural anesthesia group combined with general anesthesia ,and conventional group for gener-al anesthesia.Compare the changes of heart rate ,mean arterial pressure and serum stress response levels in three groups at different time points.The visual analog scale score ,postoperative recovery and adverse events of the three groups were compared.Results There were significant differences in heart rate and mean arterial pressure fluctuations among the 3 groups at the time of T1-T5 (P<0.05 or 0.01).There were significant differences in the levels of norepinephrine and adrenaline among the three groups at T 3 , T4 and T5 (P<0.01) ,there were significant differences in cortisol levels among the three groups at T 4 and T5 (P<0.01) ,there were no significant differences in norepinephrine ,adrenaline and cortisol levels between the dexmedetomidine group and the epidural group at the time of T 3 ,T4 ,and T5 (P>0.05). There were significant differences in the scores of the visual analog scales among the three groups (P<0.01).There was no significant difference between the dexmedetomidine group and the epidural group (P>0.05).There were significant differences in postoperative recovery time among the 3 groups (P<0.01) , and the incidence of adverse reactions was statistically significant (P<0.01).Conclusion General anesthesia combined with dexmedetomidine and general anes-thesia combined with epidural anesthesia can all in-hibit the stress response of surgical patients , maintain stable hemodynamic parameters ,shorten postoperative recovery time and improve postoperative analgesia.
作者
谢爽
冯雨人
张爽
Xie Shuang;Feng Yuren;Zhang Shuang(Nanyang Zhang Zhongjing Hospital,Nanyang 473000,Henan,China)
出处
《临床心身疾病杂志》
CAS
2019年第1期39-44,共6页
Journal of Clinical Psychosomatic Diseases
关键词
全麻
右美托咪定
硬膜外麻醉
应激反应
血流动力学
镇痛效果
General anesthesia
dexmedetomidine
epidural anesthesia
stress response
hemodynamics
analgesic effect
