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右美托咪定联合丙泊酚对腹腔镜胆囊切除术患者应激反应、血流动力学及术后并发症的影响

Effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy.

作者信息

Yang Anbo, Gao Feng

机构信息

Department of Anesthesiology, Beibei Traditional Chinese Medical Hospital Chongqing 400700, China.

Department of Anesthesiology, The Sixth People's Hospital of Chongqing Chongqing 400060, China.

出版信息

Am J Transl Res. 2021 Oct 15;13(10):11824-11832. eCollection 2021.

Abstract

OBJECTIVE

This research was designed to probe the effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy.

METHODS

Altogether 144 patients who underwent laparoscopic cholecystectomy in the Beibei Traditional Chinese Medical Hospital, the Sixth People's Hospital of Chongqing from January 2018 to July 2020 were research subjects. The control group (CG) (n=68) received propofol continuous pumping sedation, while the research group (RG) (n=76) was given dexmedetomidine combined with propofol continuous pumping sedation. The quality of postoperative recovery and incidence of postoperative complications of the two groups were observed and compared. The hemodynamic indexes (HR, SpO and MAP) before anesthesia induction (T0), tracheal intubation (T1), at the commencement of operation (T2), at the end of operation (T3), and extubation (T4) were observed. The stress response indexes (Cortisol, ACTH and norepinephrine, NE) were monitored, and the scores of pain, anxiety and cognitive dysfunction before and after operation were evaluated.

RESULTS

Compared with the CG, the incidence of postoperative complications in the RG was lower, and the quality of postoperative recovery (time of breathing recovery, eye opening, consciousness and extubation) was better. Besides, the hemodynamic indexes of the RG were more stable, and the levels of stress indexes Cortisol, ACTH, and NE were lower. The RG had VAS and SAS scores that were lower, and MMSE scores were higher.

CONCLUSION

Dexmedetomidine combined with propofol can effectively alleviate the stress response of patients undergoing laparoscopic cholecystectomy, stabilize perioperative hemodynamics, and reduce postoperative complications.

摘要

目的

本研究旨在探讨右美托咪定联合丙泊酚对腹腔镜胆囊切除术患者应激反应、血流动力学及术后并发症的影响。

方法

选取2018年1月至2020年7月在重庆市第六人民医院北碚区中医院行腹腔镜胆囊切除术的144例患者作为研究对象。对照组(CG)(n = 68)接受丙泊酚持续泵注镇静,研究组(RG)(n = 76)给予右美托咪定联合丙泊酚持续泵注镇静。观察并比较两组患者术后恢复质量及术后并发症发生率。观察麻醉诱导前(T0)、气管插管时(T1)、手术开始时(T2)、手术结束时(T3)及拔管时(T4)的血流动力学指标(心率、脉搏血氧饱和度和平均动脉压)。监测应激反应指标(皮质醇、促肾上腺皮质激素和去甲肾上腺素),并评估手术前后的疼痛、焦虑和认知功能障碍评分。

结果

与CG组相比,RG组术后并发症发生率更低,术后恢复质量(呼吸恢复时间、睁眼、意识恢复和拔管时间)更好。此外,RG组血流动力学指标更稳定,应激指标皮质醇、促肾上腺皮质激素和去甲肾上腺素水平更低。RG组视觉模拟评分(VAS)和状态焦虑量表(SAS)评分更低,简易精神状态检查表(MMSE)评分更高。

结论

右美托咪定联合丙泊酚可有效减轻腹腔镜胆囊切除术患者的应激反应,稳定围手术期血流动力学,减少术后并发症。

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