摘要
目的探讨不同麻醉方式联合腹横肌平面阻滞对老年结肠癌患者胃肠功能及可溶性上皮型钙黏蛋白(sE-cad)、单核细胞人白血病抗原-DR(mHLA-DR)水平的影响。方法选取2018年9月至2019年9月该院收治的98例需要行结肠癌根治术的老年结肠癌患者,按照随机数字表法分为观察组(49例)和对照组(49例)。两组患者均采用常规诱导,对照组采用吸入七氟烷(控制MAC值在1.0~2.0)维持,并以瑞芬太尼0.1~0.2μg·kg^-1·min^-1进行镇痛。观察组输注右美托咪定0.5μg·kg^-1·h^-1维持镇静和瑞芬太尼0.1~0.2μg·kg^-1·min^-1进行镇痛。观察并记录两组患者一般资料、术后疼痛评分、胃肠激素水平、胃肠功能恢复时间、住院时间,以及手术前后sE-cad、mHLA-DR水平和不良反应等。结果观察组患者术后6、12、48 h VAS评分显著低于对照组(P<0.05);观察组术后胃动素及胃泌素水平均优于对照组(P<0.05);观察组患者胃肠功能恢复时间(包括腹胀消失时间、腹痛消失时间、排气排便恢复时间、肠鸣音恢复时间等)及住院时间均明显低于对照组(P<0.05);术后1、3、7 d,观察组sE-cad明显低于对照组(P<0.05),mHLA-DR显著高于对照组(P<0.05)。两组患者术后均未出现严重不良反应,观察组术后出现嗜睡3例,恶心呕吐3例,低血压4例;对照组术后出现嗜睡1例,恶心呕吐5例,低血压1例。结论右美托咪定静脉麻醉能有效改善老年结肠癌患者术后疼痛及胃肠功能,并降低应激反应,值得临床推广。
Objective To explore the effects of different anesthesia methods combined with transverse abdominis plane block on gastrointestinal function,soluble epithelial cadherin(sE-cad)and monocyte human leukemia antigen-DR(mHLA-DR)levels in elderly patients with colon cancer.Methods From September 2018 to September 2019,98 elderly patients with colon cancer who needed radical resection of colon cancer were selected and divided into observation group(49 cases)and control group(49 cases)according to the random number table method.Both groups of patients were conventionally induced,and the control group was maintained by inhalation of sevoflurane(controlling MAC value between 1.0 and 2.0)and remifentanil 0.1 to 0.2μg·kg^-1·min^-1 for analgesia.The observation group was infused with dexmedetomidine 0.5μg·kg^-1·h^-1 to maintain sedation and remifentanil 0.1 to 0.2μg·kg^-1·min^-1 to provide analgesia.Observe and record the general information of the two groups of patients,postoperative pain score,gastrointestinal hormone levels,gastrointestinal function recovery time,hospital stay,as well as sE-cad,mHLA-DR levels and adverse reactions before and after surgery.Results There was no statistically significant difference between the two groups of general information(P>0.05);the VAS score of the two groups increased significantly at 6,12 and 48 h after operation(P<0.05);the VAS scores of patients in the observation group were significantly lower than those in the control group at 6 hours,12 hours after operation,and 48 hours after operation(P<0.05);there were statistically significant differences in motilin and gastrin between the two groups of patients after surgery(P<0.05),the levels of motilin and gastrin in the observation group were better than those in the control group(P<0.05);the gastrointestinal function recovery time(including the disappearance time of abdominal distension,abdominal pain disappearance time,exhaust and defecation recovery time,bowel sound recovery time,etc.)and hospitalization time of patients in the observation group were significantly lower than those in the control group(P<0.05);At 1,3,and 7 days after operation,sE-cad of the observation group was significantly lower than that of the control group(P<0.05),and mHLA-DR was significantly higher than that of the control group(P<0.05);there were no serious adverse reactions in the two groups.In the observation group,3 cases had drowsiness,3 cases of nausea and vomiting,and 4 cases of hypotension;in the control group,1 case developed drowsiness,5 cases of nausea and vomiting,and 1 case of hypotension.All of the above adverse reactions recovered after symptomatic treatment and did not cause adverse events.Conclusion Intravenous anesthesia with dexmedetomidine can effectively improve postoperative pain and gastrointestinal function in elderly patients with radical resection of bowel cancer,and reduce the level of stress response,which is worthy of clinical promotion.
作者
刘小南
斯小龙
应江明
LIU Xiaonan;SI Xiaolong;YING Jiangming(Department of Anesthesiology,People′s Hospital of Linan District,Hangzhou,Zhejiang 311300,China)
出处
《重庆医学》
CAS
2020年第19期3263-3267,共5页
Chongqing medicine
关键词
右美托咪定
结肠癌
胃肠功能
应激反应
Dexmedetomidine
colon cancer
gastrointestinal function
stress
