右美托咪定复合七氟醚麻醉接受肝叶切除术治疗原发性肝癌患者麻醉效果分析*

doi:10.3969/j.issn.1672-5069.2024.02.027

摘要/Abstract

摘要： 目的探讨原发性肝癌(PLC)患者接受肝叶切除术时行右美托咪定复合七氟醚麻醉的临床效果。方法 2019年1月～2022年12月我院收治的PLC患者57例, 采用随机数字表法将患者分为对照组28例和观察组29例, 在行肝叶切除术手术时分别采用七氟醚麻醉或右美托咪定复合七氟醚麻醉。在麻醉前(T0)、术毕即刻(T1)、术后12 h(T2)和术后24 h(T3), 常规监测心率(HR)和平均动脉压(MAP), 采用视觉模拟评分(VAS)评估疼痛程度, 采用ELISA法检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、皮质醇(Cor)和促肾上腺皮质激素(ACTH)水平。结果在T0、T1、T2和T3时, 两组HR和MAP比较, 差异无统计学意义(P＞0.05);在T1、T2和T3时, 观察组VAS评分分别为(2.1±0.5)分、(1.6±0.4)分和(1.1±0.2)分, 均显著低于对照组【分别为(2.8±0.7)分、(2.2±0.5)分和(1.5±0.3)分, P＜0.05】;在T0时, 观察组血清IL-6、TNF-α、Cor和ACTH水平分别为(5.2±1.1)ng/L、(26.9±4.3)μg/L、(185.6±28.4)mmol/L和(10.6±2.1)pmol/L, 与对照组【分别为(4.9±1.3)ng/L、(27.5±4.6)μg/L、(183.2±30.6)mmol/L和(11.3±2.5)pmol/L】比, 无显著性差异(P>0.05), 而在T3时, 观察组血清IL-6、TNF-α、Cor和ACTH水平分别为(9.7±2.6)ng/L、(31.3±4.8)μg/L、(219.7±32.5)mmol/L和(14.8±3.5)pmol/L, 均显著低于对照组【分别为(22.3±3.4)ng/L、(46.7±5.3)μg/L、(285.4±35.1)mmol/L和(29.6±4.9)pmol/L, P＜0.05】。结论应用右美托咪定复合七氟醚麻醉能减轻PLC患者接受肝叶切除术时围术期疼痛程度, 缓解围术期炎症和氧化应激反应, 值得临床进一步研究。

关键词: 原发性肝癌, 肝叶切除术, 右美托咪定, 七氟醚, 麻醉

Abstract: Objective The aim of this study was to observe the clinical efficacy of dexmedetomidine and sevoflurane combination anesthesia in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods 57 patients with PLC were enrolled in our hospital between January 2019 and December 2022, and were randomly divided into control (n=28) and observation group (n=29) during hepatectomy, receiving sevoflurane anesthesia or dexmedetomidine and sevoflurane combination anesthesia, respectively. The heart rate (HR) and mean arterial pressure (MAP) were routinely monitored before anesthesia (T0), immediately after surgery (T1), 12 h after surgery (T2) and 24 h after surgery (T3). The pain was evaluated by visual analogue scale (VAS), and serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), cortisol (Cor) and adrenocorticotropic hormone (ACTH) levels were detected by ELISA. Results At T0, T1, T2 and T3, there was no significant differences as respect to HR or MAP between the two groups (P>0.05); at T1, T2 and T3, the VAS scores in combination group were (2.1±0.5), (1.6±0.4) and (1.1±0.2), all significantly lower than in the control group; at T0, serum IL-6, TNF-α, Cor and ACTH levels in the combination group were (5.2±1.1)ng/L, (26.9±4.3)μg/L, (185.6±28.4)mmol/L and (10.6±2.1)pmol/L, not significantly different compared to in the control (P>0.05), while at T3, serum IL-6, TNF-α, Cor and ACTH levels were (9.7±2.6)ng/L, (31.3±4.8)μg/L, (219.7±32.5)mmol/L and (14.8±3.5) pmol/L, all significantly lower than in the control group. Conclusion The dexmedetomidine and sevoflurane combination anesthesia in patients with PLC during hepatectomy could alleviate perioperative pain and relieve perioperative body inflammatory and oxidative stress reactions, which is worthy of further clinical investigation.

Key words: Hepatoma, Hepatectomy, Dexmedetomidine, Sevoflurane, Anesthesia

王莹莹, 周平, 程蕾. 右美托咪定复合七氟醚麻醉接受肝叶切除术治疗原发性肝癌患者麻醉效果分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 267-270.

Wang Yingying, Zhou Ping, Cheng Lei. Clinical application of dexmedetomidine and sevoflurane combination anesthesia in patients with primary liver cancer undergoing hepatectomy[J]. Journal of Practical Hepatology, 2024, 27(2): 267-270.

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右美托咪定复合七氟醚麻醉接受肝叶切除术治疗原发性肝癌患者麻醉效果分析^*

Clinical application of dexmedetomidine and sevoflurane combination anesthesia in patients with primary liver cancer undergoing hepatectomy

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