右美托咪定联合丙泊酚麻醉对腹腔镜胆囊切除术患者镇痛效果研究

doi:10.3969/j.issn.1672-5069.2020.03.035

摘要/Abstract

摘要： 目的分析应用右美托咪定联合丙泊酚麻醉对腹腔镜胆囊切除术患者镇痛和镇静的效果。方法 2015年7月～2019年5月我院肝胆外科收治的胆囊结石患者248例,采用随机数字表法分为对照组124例和观察组124例。在行腹腔镜下胆囊切除术时,观察组在麻醉诱导插管前10 min给予右美托咪定静脉滴注,再以0.25 μg·kg^-1·h^-1静脉滴注至手术完毕。在麻醉诱导期间,给予芬太尼、咪达唑仑和丙泊酚静脉滴注,在麻醉维持期间持续给予丙泊酚和瑞芬太尼,至手术结束;对照组在麻醉诱导前给予生理盐水静脉滴注,以后除不应用右美托咪定外,其他麻醉用药同观察组。采用疼痛数字等级评分量表(NRS)和Ramsay镇静评分量表进行镇痛和镇静效果评价,采用ELISA法检测血清超氧化物歧化酶(SOD)和丙二醛(MDA)水平,采用微量法检测血清总抗氧化能力(T-AOC)水平。结果在术后2 h、6 h和12 h,观察组NRS动态评分分别为(2.5±0.7)分、(2.8±1.3)分和(2.6±1.0)分,显著低于对照组【分别为(3.1±0.6)分、(3.3±0.8)分和(3.9±0.9)分,P<0.05】,Ramsay镇静评分分别为(2.7±0.8)分、(2.7±1.0)分和(2.9±1.0)分,显著高于对照组【分别为(1.5±0.6)分、(1.9±0.5)分和(2.1±0.4)分,P<0.05】;在术后5 h,观察组血清SOD水平为(90.4±10.5) U/mL,显著高于对照组【(82.6±9.8) U/mL,P<0.05】,血清T-AOC水平为(15.3±2.4) U/mL,显著高于对照组【(12.2±2.0) U/mL,P<0.05】,而血清MDA水平为(3.2±0.6) mmol/mL,显著低于对照组【(4.5±0.8) mmol/mL,P<0.05】; 观察组苏醒后恶心、呕吐和头晕等不良反应发生率为3例(2.4%),而对照组为2例(1.6%,P>0.05),无显著性差异。结论应用右美托咪定联合丙泊酚麻醉能显著提高腹腔镜胆囊切除术患者围手术期镇痛和镇静效果,降低患者术后氧化应激反应。

关键词: 胆囊结石, 胆囊切除术, 右美托咪定, 丙泊酚, 麻醉, 氧化应激反应 , ,

Abstract: Objective The aim of this study was to analyze the analgesic and sedative effects of dexmedetomidine and propofol combination in patients undergoing laparoscopic cholecystectomy (LC). Methods 248 patients with holecystolithiasis were admitted to the Department of Hepatobiliary Surgery in our hospital between July 2015 and May 2019, and were randomly divided into control and observation group, 124 cases in each. All the patients underwent LC, and the patients in observation group were given intravenous infusion of dexmedetomidine at 0.5 g.kg^-1 10 minutes before the anesthesia induction intubation, followed by intravenous infusion of it at 0.25 g.kg^-1·h^-1 until the operation was completed. The patients in control group were intravenously given normal saline before the induction of anesthesia, and the other anesthetic drugs were the same except dexmedetomidine. The analgesia and sedation were evaluated by numerical rating scale (NRS) and Ramsay scale. Serum dismutase (SOD)and malonicdialdehyde (MDA) were detected by ELISA, and serum total superoxide antioxidant capacity (T-AOC) was also obtained. Results At two, six and twelve hours, the NRS score in the observation group were (2.5±0.7), (2.8±1.3) and (2.6±1.0), significantly lower than 【(3.1±0.6), (3.3±0.8) and (3.9±0.9), respectively, P<0.05】 in the control, and Ramsay scale score were (2.7±0.8), (2.7±1.0) and (2.9±1.0), significantly higher than 【(1.5±0.6), (1.9±0.5) and (2.1±0.4), respectively, P<0.05】; at five hour post-operation, serum SOD level in the observation group was (90.4±10.5) U/mL, significantly higher than 【(82.6±9.8) U/mL, P<0.05】 in the control, serum T-AOC was (15.3±2.4) U/mL, much higher than 【(12.2±2.0) U/mL, P<0.05】 in the control, while serum MDA level was (3.2±0.6) mmol/mL, significantly lower than 【(4.5±0.8) mmol/mL, P<0.05】 in the control; the incidence of adverse reactions such as nausea, vomiting and dizziness was not significantly different between the two groups (2.4% vs. 1.6%, P>0.05). Conclusion The application of dexmedetomidine and propofol combination for anesthesia in patients with cholecystolithiasis undergoing LC is efficacious for improving the perioperative analgesia and sedation, which might be related to the inhibition of oxidative stress and is worthy of clinical verification.

Key words: Cholecystolithiasis, Dexmedetomidine, Propofol, Laparoscopic cholecystectomy, Anesthesia, Oxidative stress

陈显宇,何川. 右美托咪定联合丙泊酚麻醉对腹腔镜胆囊切除术患者镇痛效果研究[J]. 实用肝脏病杂志, 2020, 23(3): 443-446.

Chen Xianyu,He Chuan. Efficacy of dexmedetomidine and propofol analgesia and sedation in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2020, 23(3): 443-446.

参考文献

[1] Longo MA, Cavalheiro B T, de Oliveira F G. Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses. J Clin Anesth, 2017, 41(7): 48-54.
[2] 伍家彬, 谢晓海. 丙泊酚对肝部分切除术治疗的原发性肝癌患者外周血淋巴细胞亚群和血清肿瘤相关标志物水平的影响. 实用肝脏病杂志, 2018, 21(5): 745-748.
[3] Bakan M, Umutoglu T, Topuz U, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol, 2015, 65(3): 191-199.
[4] Chou A H, Liao C C, Lee H C, et al. The map2k4/jnk/c-jun signaling pathway plays a key role in dexmedetomidine protection against acetaminophen-inducedliver toxicity. Drug Des Devel Ther, 2019, 13(5): 3887-3898.
[5] Xia M, Ji N N, Duan M L, et al. Dexmedetomidine regulate the malignancy of breast cancer cells by activating alpha2-adrenoceptor/erk signaling pathway. Eur Rev Med Pharmacol Sci, 2016, 20(16): 3500-3506.
[6] 中国中西医结合学会消化系统疾病专业委员会. 胆石症中西医结合诊疗共识. 中国中西医结合杂志, 2011, 31(8): 1041-1043.
[7] 庞刚, 张勇. 全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用. 实用肝脏病杂志, 2015, 18(4): 403-406.
[8] Kallioinen M, Scheinin A, Maksimow M, et al. The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects. BMC Anesthesiol, 2019, 19(1): 222.
[9] Cagle LA, Franzi LM, Epstein SE, et al. Injectableanesthesia for mice: combined effects of dexmedetomidine, tiletamine-zolazepam, and butorphanol. Anesthesiol Res Pract, 2017, 2017(11): 9161040.
[10] 赵方, 银瑞, 马从乾. 丙泊酚复合芬太尼静脉复合全麻在主动脉夹层介入手术治疗中的麻醉效果分析. 中国普通外科杂志, 2016(25): 925.
[11] Cozzi G, Norbedo S, Barbi E. Intranasaldexmedetomidine for procedural sedation in children, a suitable alternative to chloral hydrate. Paediatr Drugs, 2017, 19(2): 107-111.
[12] 陈仁军, 沈学用, 倪辉,等. 舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉在腹腔镜胆囊切除术的效果比较. 中国普通外科杂志, 2018,44(8): 1041-1047.
[13] Koceroglu I, Devrim S, Bingol T T, et al. The effects of dexmedetomidine and tramadol on post-operative pain and agitation, and extubation quality in paediatric patients undergoing adenotonsillectomy surgery: A randomized trial. J Clin Pharm Ther, 2019, 8(4): 145-146.
[14] Du X, Song F, Zhang X, et al. Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Acta Cir Bras, 2019, 34(9): 201900905.
[15] Akbulut S. Comment on "a systematic review of laparoscopic cholecystectomy in situs inversus". J Invest Surg, 2019, 11(13): 1-4.
[16] Wang XT, Tian Y, Xu WX, et al. Protective effects of modeled superoxide dismutase coordination compound (msoda) against ischemia/reperfusioninjury in rat skeletal muscle. Cell Physiol Biochem, 2015, 37(2): 465-476.
[17] Kilic N, Yavuz TM, Guney Y, et al. An investigation into the serum thioredoxin, superoxide dismutase, malondialdehyde, and advanced oxidation protein products in patients with breast cancer. Ann Surg Oncol, 2015, 21(13): 4139-4143.
[18] Mergeay M, Verster A, Van Aken D, et al. Regional versus general anesthesia for spine surgery. A comprehensive review. Acta Anaesthesiol Belg, 2015, 66(1): 1-9.
[19] Kim KM, Seo KH, Lee JM, et al. Target-controlled infusion of dexmedetomidine effect-site concentration for sedation in patients undergoing spinal anaesthesia. J Clin Pharm Ther, 2019, 34(45): 245-247.
[20] Koceroglu I, Devrim S, Bingol TT, et al. The effects of dexmedetomidine and tramadol on post-operative pain and agitation, and extubation quality in paediatric patients undergoing adenotonsillectomy surgery: A randomized trial. J Clin Pharm Ther, 2019, 23(12): 167-170.