Page 85 - 《中国药房》2020年22期
P. 85

Clinical Observation of Dexmedetomidine Combined with Butorphanol for Laparoscopic Radical Resection
        of Colorectal Cancer
        YANG Chen,GAO Na,LU Xihua(Dept. of Anesthesia and Perioperative Medicine,the Affiliated Cancer
        Hospital of Zhengzhou University,Zhengzhou 450008,China)

        ABSTRACT    OBJECTIVE:To observe the anesthetic effect and safety of dexmedetomidine combined with butorphanol for
        laparoscopic radical resection of colorectal cancer. METHODS:Totally 180 patients undergoing elective laparoscopic radical
        resection of colorectal cancer were selected from our hospital during Apr. 2019-May 2020. They were randomly divided into control
        group(group C),dexmedetomidine group(group D),butorphanol group(group B),dexmedetomidine+butorphanol group(group
        E),with 45 cases in each group. Group C received rountine anesthesia of Etomidate emulsion injection+Sufentanil citrate injection+
        Cisatracurium besylate for injection. Group D was given Dexmedetomidine injection 0.5 μg/kg by pumping 15 min before induction,
        and received rountine anesthesia indution performed in group C. Group B was given intravenous injection of Butorphanol tartrate
        injection 0.02 mg/kg when anesthesia indution,and received rountine anesthesia performed in group C. Anesthesia induction in
        group E was the same as that in group D + B. The dosage of sufentanil and the maintenance concentration of sevoflurane were
        observed;average arterial pressure(MAP)and heart rate(HR)at the time of entering the room(T0 ),1 min after intubation(T1 ),
        1 min after skin incision(T2 ),and 5 min after extubation(T3 ),extubation time,Ramsay sedation score 5 min after extubation and
        VAS score,the occurrence of ADR were recorded. RESULTS:One patient in group C and two patients in Group E were excluded
        due to the conversion of laparoscopic surgery to open surgery. The rest of the patients completed the study. At T1-T3,MAP and HR
        in group C,D and B were significantly higher than those at T0(P<0.05),while there was no significant difference in MAP or HR

        in group E at T1-T3,compared with those at T0(P>0.05). MAP of group D and B at T1-T2 as well as MAP of group E at T1-T3
        were significantly lower than that of group C,the order was group E<group B<Group D(except for group B compared with
        group D at T3 );HR of group D and E at T1-T3 as well as that of group B at T1-T2 were significantly lower than group C,and the
        order was group E<group B<Group D(except for group B compared with group D at T3 )(P<0.05). The amount of sufentanil
        and VAS score of group B,D,E were significantly lower than that of group C,and the order was group E<group B<group D,
        VAS score of group E<group D,B (P<0.05). The maintenance concentration,extubation time,nausea and vomiting,the
        incidence of agitation during recovery period in group E were significantly lower or shorter than group C,D,B. Ramsay sedation
        score was significantly higer than group C,D and B. The nausea and vomiting,the incidence of emergence agitation in group E<
        group D,B(P<0.05). There was no statistical significance in the maintenance concentration of sevoflurane,Ramsay sedation
        score or extubation time among group C,D and B,VAS score,the incidence of nausea and vomiting,the incidence of agitation
        during recovery period between group D and B(P>0.05). CONCLUSIONS:Dexmedetomidine combined with butorphanol can
        effectively reduce the amount of intraoperative anesthetics and the occurrence of stress reaction, improve the quality of
        resuscitation,and reduce the incidence of postoperative ADR.
        KEYWORDS    Dexmedetomidine;Butorphanol;Colorectal cancer;Laparoscopic radical resection;Anesthetic effect;Safety

                                           [1]
            结直肠癌是世界上第三大常见癌症 。虽然,随着                         率,镇静效果显著,减少了单一麻醉药物剂量,降低了围
        分子生物学及遗传学的发展,化疗、放疗、靶向治疗等方                          术期不良反应的发生风险 。为此,本研究观察了右美
                                                                                  [7]
        式已相继被应用于临床,但手术切除仍是目前结直肠癌                           托咪定联合布托啡诺用于腹腔镜结直肠癌根治术的麻
                      [2]
        治疗的主要方式 。腹腔镜手术因创伤小、出血少、恢复                          醉效果及安全性,旨在为临床用药提供参考。
                                    [3]
        快而被广泛应用于结直肠癌患者 。为减少患者围术期                           1 资料与方法
        并发症和不良事件的发生、促进其快速康复,对围术期                           1.1 纳入、排除与剔除标准
        麻醉方案进行优化显得尤为重要。                                        纳入标准:(1)经电子计算机断层扫描(CT)、电子结
            右美托咪定是一种高选择性的α 2肾上腺素能受体                        肠镜及病理组织学检查确诊为结直肠癌,Dukes分期A、
        激动药,具有降低交感神经张力,抑制去甲肾上腺素释                           B、C期,且有明确的手术指征;(2)拟行腹腔镜根治术治
        放,减轻应激反应 ,镇静、镇痛,减少患者术后谵妄和躁                         疗;(3)年龄 45~65 岁;(4)美国麻醉医师协会(ASA)分
                       [4]
                [5]
                                                                                                  2
        动的优点 。酒石酸布托啡诺是一种混合型阿片类受体                           级Ⅰ~Ⅲ级;(5)体质量指数(BMI)<30 kg/m 。
        激动-拮抗药,具有镇痛、镇静作用,能减轻强阿片类药                              排除标准:(1)凝血功能异常者;(2)房室传导阻滞、
        物引起的呼吸抑制、恶心呕吐等副作用 。有研究表明,                          病窦综合征者;(3)有精神病史者;(4)长期服用镇静、镇
                                         [6]
        右美托咪定联合布托啡诺可有效降低行尿道前列腺电                            痛药者;(5)有恶性高热家族史者;(6)有麻醉药过敏史
        切术良性前列腺增生老年患者的术中寒战程度及发生                            者;(7)严重心、肺、肝、肾功能障碍者;(8)癌灶发生远处


        中国药房    2020年第31卷第22期                                            China Pharmacy 2020 Vol. 31 No. 22  ·2763 ·
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