目的:观察右美托咪定联合舒芬太尼麻醉在腹腔镜胃肠穿孔修补术患者中的临床运用,分析患者手术前后血流动力学、应激反应和炎性因子水平的变化。方法:将收治的102例行腹腔镜胃肠穿孔修补术患者按照抽签法随机分为对照组(n=51)和观察组(n=51),其中对照组给予舒芬太尼麻醉,观察组给予右美托咪定联合舒芬太尼麻醉,其他联合麻醉药物均相同。检测所有受试者麻醉诱导前(T1)、给药10 min后(T2)、气腹时(T3)和拔管后(T4)血流动力学及术前和术后24 h血清应激反应指标和炎性因子水平。结果:T1和T2时,两组血流动力学比较,差异无显著性(P>0.05)；T3和T4时,观察组HR、SBP和DBP均显著低于同期对照组(P<0.05),且与T1时观察组比较无明显差异(P>0.05)；T3和T4时,对照组HR、SBP和DBP比T1时显著增高(P<0.05)。术前,两组血清应激激素指标无显著性差异(P>0.05)；术后24 h,两组血清ACTH、Cor和ALD水平均高于术前,且观察组显著低于同期对照组(P<0.05)。术前,两组血清炎性因子水平无显著性差异(P>0.05)；术后24 h,两组血清IL-10和TNF-α水平均高于术前(P<0.05),且观察组显著低于同期对照组(P<0.05)。结论:右美托咪定联合舒芬太尼麻醉能够维持患者血流动力学稳定,降低患者应激反应和血清炎性因子浓度,是潜在有效麻醉方案之一。

Objective: To observe the clinical application of dexmedetomidine combined with sufentanil anesthesia in patients undergoing laparoscopic gastrointestinal perforation repair, and the changes of hemodynamics, stress response and inflammatory factors were analyzed before and after operation. Methods: 102 patients with laparoscopic gastrointestinal perforation were randomly divided into control group (n=51) and observation group (n=51) according to the lottery method. The control group was given anesthesia with sufentanil, and the observation group was given dexmedetomidine combined with sufentanil anesthesia, and the other anesthesia drugs were the same. The hemodynamics, serum stress response and inflammatory factor levels were measured in all subjects. Results:At T1 and T2, there was no significant difference between the two groups in hemodynamics (P>0.05). At T3, and T4, HR, SBP, and DBP in the observation group were significantly lower than those in the control group (P<0.05), and which compared with the observation group were no significant difference (P>0.05). At T3, and T4, the HR, SBP and DBP of the control group were significantly higher than those of T1 (P<0.05). There was no significant difference in serum stress hormone between the two groups before surgery (P>0.05). After surgery 24 hours , two groups of serum ACTH, Cor and ALD levels were higher than those of preoperative, and the observation group was significantly lower than those of the control group (P<0.05). There was no significant difference in serum inflammatory cytokines between the two groups before surgery (P>0.05). After surgery 24 hours, the levels of serum IL-10 and TNF-α in the two groups were higher than those before operation (P<0.05), and the observation group was significantly lower than those of the control group (P<0.05). Conclusion: The combination of dexmedetomidine and sufentanil anesthesia can maintain the hemodynamic stability of patients, reduce the stress response and serum inflammatory factor concentration, which is one of the potential effective anesthesia compound.

R573

湖北省十堰市太和医院院级课题(2016JJXM054)