Department of Anesthesiology, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, China.
Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China.
Medicine (Baltimore). 2024 Nov 1;103(44):e39669. doi: 10.1097/MD.0000000000039669.
Gastric cancer is the third most common malignant tumor with the second highest mortality rate in the world, and radical gastrectomy is the main treatment method, but the operation needs a long period of time to carry out and has strong surgical trauma stimulation, which is likely to cause sympathetic nerve excitement and stress reaction in the body. Therefore, the selection of appropriate anesthetic medication regimen and anesthesia method has an important impact on the intraoperative management and postoperative recovery of patients. This study aims to compare the clinical effects of dexmedetomidine alone in combination with propofol, etomidate and propofol-etomidate mixture in the treatment of radical gastrectomy for gastric cancer.
A total of 90 patients undergoing elective radical gastrectomy were randomly divided into the propofol group (group P), the etomidate group (group E), and the etomidate-propofol mixture group (group PE). Anesthesia induction was performed under the monitoring of bispectral index anesthesia depth. The same pumping drugs were used in 3 groups: 0.1 to 0.3 μg/kg·min remifentanil, 0.5 μg/kg·h dexmedetomidine, and 5 to 10 μg/kg·min rocuronium. The primary outcome indicator was the hemodynamic conditions. The secondary outcome indicators included awakening time and time to accurately answer questions after operation, the prevalence of postoperative respiratory depression and adverse events, the incidence of postoperative cognitive dysfunction, and preoperative and postoperative Montreal Cognitive Assessment and Mini-Mental State Examination scores.
Among the 3 groups of patients, the use rate of vasoactive drugs in group P was higher (P < .05); the systolic blood pressure, diastolic blood pressure, and heart rate of group P at T1 to T4 were significantly lower than those of groups E and PE (P < .05); the systolic blood pressure, diastolic blood pressure, and heart rate of group E in T2, T4, and T6 were significantly higher than those of groups P and PE (P < .05). The wake-up time after operation and the time to accurately answer the questions were longer in group E than in groups P and PE (P < .05). The incidence of postoperative respiratory depression in group P was higher than that in groups E and PE (P < .05). The Montreal Cognitive Assessment score of group P was lower than that of groups E and PE 7 days after operation (P < .05).
Dexmedetomidine combined with propofol-etomidate mixture is a better anesthesia drug combination.
胃癌是全球发病率第三、死亡率第二的恶性肿瘤，根治性胃切除术是其主要治疗手段，但手术操作时间长，具有较强的手术创伤刺激，易引起机体交感神经兴奋和应激反应。因此，选择合适的麻醉药物方案和麻醉方法对患者的术中管理和术后恢复具有重要影响。本研究旨在比较右美托咪定单独与依托咪酯、丙泊酚和依托咪酯-丙泊酚混合液在胃癌根治术中的临床效果。
选择择期行根治性胃切除术的患者 90 例，随机分为丙泊酚组（P 组）、依托咪酯组（E 组）和依托咪酯-丙泊酚混合液组（PE 组）。3 组均在脑电双频指数监测下进行麻醉诱导，泵注相同的药物：0.1～0.3μg/kg·min 瑞芬太尼、0.5μg/kg·h 右美托咪定、5～10μg/kg·min 罗库溴铵。主要观察指标为血流动力学变化。次要观察指标包括术后苏醒时间和准确回答问题的时间、术后呼吸抑制的发生率和不良反应、术后认知功能障碍的发生率、术前和术后蒙特利尔认知评估量表和简易精神状态检查评分。
3 组患者中，P 组血管活性药物使用率较高（P＜0.05）；P 组 T1 至 T4 时的收缩压、舒张压和心率明显低于 E 组和 PE 组（P＜0.05）；E 组 T2、T4、T6 时的收缩压、舒张压和心率明显高于 P 组和 PE 组（P＜0.05）。E 组术后苏醒时间和准确回答问题时间长于 P 组和 PE 组（P＜0.05）。P 组术后呼吸抑制发生率高于 E 组和 PE 组（P＜0.05）。P 组术后 7 天蒙特利尔认知评估量表评分低于 E 组和 PE 组（P＜0.05）。
右美托咪定复合依托咪酯-丙泊酚混合液是一种较好的麻醉药物组合。
