右美托咪定复合丙泊酚麻醉精准肝切除术治疗肝内胆管结石患者麻醉效果分析*

doi:10.3969/j.issn.1672-5069.2025.02.035

摘要/Abstract

摘要： 目的分析右美托咪定复合丙泊酚麻醉对精准肝切除术治疗的肝内胆管结石(IHBDS)患者的麻醉效果。方法 2018年1月～2022年12月我院收治的IHBDS患者91例,均接受精准肝切除术治疗,其中45例对照组采用丙泊酚麻醉,46例观察组采用右美托咪定复合丙泊酚麻醉。在麻醉诱导前(T0)、术毕即刻(T1)、术后2 h(T2)、术后6 h(T3)和术后12 h(T4)常规监测心率(HR)和平均动脉压(MAP),应用疼痛数字评价量表(NRS)和Ramsay镇静量表(RSS)评估镇痛和镇静效果。采用ELISA法检测血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)和丙二醇(MDA)水平。结果观察组拔管时间和苏醒时间分别为(14.3±2.9)min和(15.7±3.8)min,均显著短于对照组【分别为(17.0±3.2)min和(18.4±4.1)min,P＜0.05】;在T2、T3和T4时刻,观察组动态NRS评分分别为(3.5±0.7)分、(3.1±0.6)分和(2.8±0.4)分,均显著低于对照组【分别为(4.1±1.1)分、(3.7±0.7)分和(3.3±0.6)分,P＜0.05】; RSS评分分别为(2.6±0.5)分、(2.8±0.6)分和(2.9±0.8)分,均显著高于对照组【分别为(1.9±0.8)分、(2.1±0.8)分和(2.2±0.9)分,P＜0.05】;在T4时刻,观察组血清Cor、ACTH和MDA水平分别为(234.1±32.7)mmol/L、(17.6±5.3)pmol/L和(3.3±0.7)mmol/mL,均显著低于对照组【分别为(274.3±38.4)mmol/L、(25.7±6.9)pmol/L和(4.2±0.9)mmol/mL,P＜0.05】。结论应用右美托咪定复合丙泊酚麻醉能提高IHBDS患者接受精准肝切除术手术的麻醉效果,术后镇痛和镇静好,可能与缓解了机体氧化应激反应有关,值得临床进一步研究。

关键词: 肝内胆管结石, 精准肝切除术, 右美托咪定, 丙泊酚, 麻醉

Abstract: Objective The aim of this study was to investigate anesthetic efficacy of dexmedetomidine in combination with propofol in patients with intrahepatic bile duct stones (IHBDS) undergoing precise hepatectomy (pHT). Methods A total of 91 patients with IHBDS were encountered in our hospital between January 2018 and December 2022, and all underwent pHT. For anesthesia, 45 patients in control group received propofol and 46 patients in observation group received dexmedetomidine and propofol combination. Parameters were routinely monitored before anesthesia induction (T0), immediately after surgery (T1), at 2 hours after surgery (T2), 6 hours after surgery (T3) and 12 hours after surgery (T4). Postoperative analgesia and sedation efficacy were evaluated by numerical rating scale (NRS) and Ramsay sedation scale (RSS), respectively. Serum cortisol (Cor), adrenocorticotropin (ACTH) and malondialdehyde (MDA) levels were detected by ELISA. Results The extubation time and awaking time in the observation group were (14.3±2.9) min and (15.7±3.8) min, significantly shorter than those in control group [(17.0±3.2) min and (18.4±4.1) min, P<0.05]; by T2, T3 and T4, dynamic NRS scores in the observation groups were (3.5±0.7) points, (3.1±0.6) points and (2.8±0.4) points, significantly lower than those in control group [(4.1±1.1) points, (3.7±0.7) points and (3.3±0.6) points, P<0.05], while RSS scores were (2.6±0.5) points, (2.8±0.6) points and (2.9±0.8) points, significantly higher than those in the control group [(1.9±0.8) points, (2.1±0.8) points and (2.2±0.9) points, P<0.05]; at T4, serum Cor, ACTH and MDA levels in the observation group were (234.1±32.7) mmol/L, (17.6±5.3) pmol/L and (3.3±0.7) mmol/mL, all significantly lower than those in the control group [(274.3±38.4) mmol/L, (25.7±6.9) pmol/L and (4.2±0.9) mmol/mL, P<0.05]. Conclusion Combiantion of dexmedetomidine and propofol could improve anesthetic efficacy, with satisfactory postoperative analgesia and sedation, which might be related to inhibition of body oxidative stress response in patients with IHBDS undergoing pHT, and is worthy of further clinical study.

Key words: Intrahepatic bile duct stones, Precise hepatectomy, Dexmedetomidine, Propofol, Anesthesia

李娟, 程豪, 杨华. 右美托咪定复合丙泊酚麻醉精准肝切除术治疗肝内胆管结石患者麻醉效果分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 298-301.

Li Juan, Cheng Hao, Yang Hua. Anesthetic efficacy of dexmedetomidine in combination with propofol in patients with intrahepatic bile duct stones underwent precise hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(2): 298-301.

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右美托咪定复合丙泊酚麻醉精准肝切除术治疗肝内胆管结石患者麻醉效果分析^*

Anesthetic efficacy of dexmedetomidine in combination with propofol in patients with intrahepatic bile duct stones underwent precise hepatectomy

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