右美托咪定辅合全麻对腹腔镜胃切除术后肠麻痹发生的影响

目的 评价右美托咪定辅合全麻对腹腔镜下胃大部切除术后肠麻痹的影响.方法 择期全麻腹腔镜下胃大部切除患者60例,性别不限,年龄30 ～ 65岁,体重指数20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):常规组(C组)和右美托咪定复合麻醉组(D组).D组行气管插管术后静脉输注右美托咪定1μg/kg持续10 min,随后以0.2 μg·kg-1·h-1速度输注至术后48 h,C组静脉输注等容量生理盐水.术后48 h内行PCIA(舒芬太尼150μg+恩丹司琼16 mg+生理盐水139 ml,输注速率2 ml/h,PCA剂量0.5 ml,锁定时间15 min).于麻醉前即刻(T0)、术后24h (T3)、48 h(T4)时抽取静脉血2ml,采用ELISA法测定血清C-反应蛋白(CRP)浓度及血浆IL-6浓度.记录术后48 h内按压总次数,舒芬太尼用量.记录术后首次排气排便时间.结果 与C组比较,D组患者在T3、T4时IL-6(51±13)pg/ml比(38±12) pg/ml、(39±10) pg/ml比(30±9)pg/ml]和CRP浓度(18.5±4.3) mg/L比(9.5±4.1)mg/L、(12.4±3.7)mg/L比(7.1±3.5)mag/L]均降低;PCIA总按压次数减少(18.2±3.1)次/48h比(8.1±2.6)次/48 h],舒芬太尼用量降低(115±4)μg/48 h比(102±4)μg/48 h];恶心呕吐发生率(35.7％比7.1％)下降,排气排便时间(60±11)h比(48±13)h、(76±13)h比(66±12) h]缩短(P＜0.05).结论 右美托咪定可缩短腹腔镜下胃大部切除患者术后肠麻痹时间,有利于肠蠕动的恢复.

Effect of dexmedetomidine on postoperative enteroplegia in patients undergoing laparoscopic subtotal gastrectomy

Objective To evaluate the effect of dexmedetomidine on postoperative enteroplegia in patients undergoing laparoscopic subtotal gastrectomy.Methods Sixty patients,aged from 30 to 65 years old,with body mass index of 20-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,were randomly divided into control group (group C) and dexmedetomidine group (group D) with the random number table,30 cases in each group.In group D,dexmedetomidine 1 μ g/kg was infused intravenously for l0 min,followed by continuous infusion of dexmedetomidine at 0.2 μ g · kg-1 · h-1 until 48 h post-surgery;while in group C the equal volume of normal saline was given instead.PCIA was performed with sufentanil 150 μ g + ondansetron 16 mg in 139 ml of normal saline within 48 h after operation (background infusion at 2 ml/h with a bolus dose of 0.5 ml and a 15 min lockout interval).Immediately before induction of anesthesia (T0,baseline),24 h after surgery (T3),and 48 h after surgery (T4),blood samples were collected for measurement of the levels of interleukin-6 (IL-6) and C-reactive protein (CRP).The number of attempts,consumption of sufentanil were recorded within 48h after operation.Results Compared with group C,the levels of IL-6 (51±13)pg/ml vs (38±12)pg/ml,(39±10)pg/ml vs (30±9)pg/ml] and CRP (18.5±4.3)mg/L vs (9.5±4.1)mg/L,(12.4±3.7)mg/L vs (7.1±3.5)mg/L] in group D were lower at T3,4,and the number of attempts was less (18.2±3.l)times/48h vs (8.l±2.6)times/48h],the consumption of sufentanil was less (115±4)μ g/48h vs (102±4)μ g/48h],the incidence of nausea and vomiting was lower (35.7％ vs 7.1％),the time of flatus and defecation were shorter (60±11)h vs (48±13)h,(76±13)h vs (66±12)h] (P＜0.05).Conclusion Dexmedetomidine can shorten time of postoperative enteroplegia in patients undergoing laparoscopic subtotal gastrectomy,and is beneficial to the recovery of intestinal peristalsis.