摘要
目的探讨围手术期帕瑞昔布钠联合右美托咪定(dexmedetomidine,Dex)对老年患者腹腔镜胃癌手术术后胃肠功能的影响。方法择期行腹腔镜胃癌手术的患者90例,年龄65~85岁,ASA分级Ⅰ、Ⅱ级,采用随机数字表法将患者分为3组(每组30例):帕瑞昔布钠组(P组)、Dex组(D组)、二者联合组(PD组)。麻醉诱导前15 min,P组、PD组给予帕瑞昔布钠40 mg+生理盐水稀释成5 ml静脉推注;D组、PD组给予Dex 1μg/kg负荷量泵注10 min,后以0.3μg·kg^-1·min^-1泵注维持,手术结束前30 min停止输注。术后均用舒芬太尼加氟比洛芬酯注射液行患者自控静脉镇痛。分别于麻醉前15 min(T0)、手术开始后1 h(T1)、手术结束时(T2)采集桡动脉血,ELISA法检测炎性因子(IL-2、IL-6、TNF-α)含量。记录患者术后首次通气时间、进流质时间、下床时间、术后住院时间、住院费用,记录患者术后2、12、24 h疼痛评分(VAS静态/动态)以及术后并发症发生情况。结果与T0时比较,3组患者T1、T2时IL-6、TNF-α含量明显升高,IL-2含量明显降低(P<0.05);PD组T1、T2时IL-6、TNF-α含量明显低于P组、D组,IL-2含量高于P组、D组(P<0.05);PD组首次通气时间、进流质时间、下床时间、术后住院时间、住院费用均明显少于P组、D组(P<0.05);PD组患者术后并发症发生率低于P组、D组(P<0.05)。结论帕瑞昔布钠联合Dex可有效减轻老年患者腹腔镜胃癌手术术后炎性应激反应,利于胃肠道快速恢复,减少患者术后住院时间和住院费用,降低术后并发症。
Objective To investigate the effect of perioperative intravenous lidocaine infusion on postoperative early recovery quality in patients undergoing upper airway surgery.Methods One hundred and twenty patients undergoing upper airway surgery were divided into two groups according to a random number table:a lidocaine group(group L)and a control group(group C),with 60 patients in each group.Group L was administered with 2.0 mg/kg lidocaine over 10 min before induction of anesthesia,followed by intravenous infusion at 2 mg·kg^?1·h^?1 until the end of surgery.Group C was given the same volume of normal saline.The 40-item Quality of Recovery Score(QoR-40 score)as well as the consumption of sufentanil and remifentanil during surgery and the incidence of postoperative nausea and vomiting(PONV)were recorded before surgery(T0),24 h after surgery(T1)and 48 h after surgery(T2).Results The global QoR-40 scores and the scores for physical comfort,physical independence,psychological support and pain at T1 and T2 in two groups as well as the score for emotional state at T1 in group C were significantly lower than those at T0(P<0.05).Compared with those in group C,the global QoR-40 scores and the scores for physical comfort,emotional state,and pain significantly increased in group L at T1 and T2(P<0.05),where the score for physical independence in group L was superior to that in group C at T1(P<0.05).Compared with those in group C,the dosage of remifentanil used during surgery and the incidence of PONV within 48 h in group L significantly reduced(P<0.05).Conclusions Perioperative intravenous lidocaine infusion can improve QoR-40 scores in patients two days after upper airway surgery,reduce the dosage of opioids and the incidence of PONV and improve postoperative early recovery quality.
作者
张玉琴
李元海
夏晓琼
夏书江
查显忠
张庆梅
王亮
Zhang Yuqin;Li Yuanhai;Xia Xiaoqiong;Xia Shujiang;Zha Xianzhong;Zhang Qingmei;Wang Liang(Department of Anesthesiology,Chaohu Hospital Affiliated to Anhui Medical University,Chaohu 238000,China;Department of Anesthe siology,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第1期48-52,共5页
International Journal of Anesthesiology and Resuscitation
关键词
帕瑞昔布钠
右美托咪定
老年人
腹腔镜治疗
胃肠手术
Parecoxib sodium
Dexmedetomidine
Aged
Therapeutic laparoscopy
Gastrointestinal surgery
