何慧娟　　漆勇　　李萍　　毕兴华　　刘礼霞

[摘要] 目的 分析予以肝癌切除術患者右美托咪定复合全麻的麻醉效果及对血流动力学的影响。 方法 将2018年1月至2020年6月于本院择期开展全麻肝癌切除术的200例患者为研究对象，依据随机数表法分成对照组（全麻诱导前10 min静脉予0.9%氯化钠注射液）和观察组（全麻诱导前10 min静脉予右美托咪定）各100例，比较两组不同时间点平均动脉压（MAP）与心率、静息疼痛数字评分（NRS）与Ramsay镇静评分、术中血管活性药使用比例、麻醉药用量、术后并发症与首次排气时间。 结果 观察组T1、T2、T4、T5、T6及T7的MAP水平和T1、T3、T4、T5及T6的心率水平低于对照组，T4、T5、T6及T7的静息NRS和T4、T5的Ramsay镇静评分低于对照组，差异有统计学意义（P<0.05）;观察组瑞芬太尼、丙泊酚及曲马多用量少于对照组，艾司洛尔以及乌拉地尔使用比例低于对照组，阿托品使用比例高于对照组，差异有统计学意义（P<0.05）;观察组并发症出现少于对照组，术后排气时间短于对照组，差异有统计学意义（P<0.05）。 结论 对行肝癌切除术的患者开展右美托咪定复合全麻能获取良好围术期镇痛镇静效果，且血流动力学及麻醉恢复期平稳，能减少麻醉及镇痛药用量，减少并发症出现，有助于术后肠道功能恢复。

[关键词] 肝癌切除术;全身麻醉;右美托咪定;麻醉效果;血流动力学;平均动脉压

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2021）09-0129-05

Research on the impacts of dexmedetomidine combined with general anesthesia on anesthesia effect and hemodynamics in patients undergoing liver cancer resection

HE Huijuan   QI Yong   LI Ping   BI Xinghua   LIU Lixia

Department of Anesthesiology， Ningbo Medical Center Lihuili Hospital， Ningbo   315000， China

[Abstract] Objective To analyze the impacts of dexmedetomidine combined with general anesthesia on anesthesia effect and hemodynamics in patients undergoing liver cancer resection. Methods A total of 200 patients undergoing liver cancer resection under general anesthesia admitted to our hospital from January 2018 to June 2020 were selected as the research objects， and they were divided into the control group（n=100） and the observation group（n=100） according to the random number table method. The control group was intravenously given 0.9% sodium chloride injection 10 min before induction of general anesthesia， while the observation group was intravenously given dexmedetomidine 10 min before induction of general anesthesia. The mean arterial pressure（MAP）， heart rate， resting pain numerical rating scale（NRS）， Ramsay sedation score， proportion of vasoactive drugs used during operation， anesthetic dosage， incidence of postoperative complications and first exhaust time were compared between the two groups at different time points. Results MAP levels of T1， T2， T4， T5， T6 and T7 and heart rate levels of T1， T3， T4， T5 and T6 in the observation group were lower than those in the control group， while resting NRS of T4， T5， T6 and T7 and Ramsay sedation scores of T4 and T5 were lower than those in the control group， with statistically significant differences（P<0.05）. In the observation group， the dosage of remifentanil， propofol and tramadol was less than that in the control group， the proportion of esmolol and urapidil in the observation group was lower than that in the control group， and the proportion of atropine in the observation group was higher than that in the control group， with statistically significant differences（P<0.05）. The incidence of complications in the observation group was less than that in the control group， and the postoperative exhaust time was shorter than that in the control group， with statistically significant differences（P<0.05）. Conclusion The application of dexmedetomidine combined general anesthesia in patients undergoing liver cancer resection can obtain good anesthesia and sedation effects during perioperative period， and the hemodynamics and recovery period of anesthesia are stable， which can reduce the dosage of anesthesia and analgesics， reduce the incidence of complications and contribute to the rehabilitation of intestinal function after operation.

[Key words] Liver cancer resection; General anesthesia; Dexmedetomidine; Anesthesia effect; Hemodynamics; Mean arterial pressure

肝癌作为我国目前较为常见的恶性肿瘤之一，死亡率仅在食管癌和胃癌之后。目前临床治疗时多选择手术切除。开展肝癌切除术的患者常伴随肝功能损伤，在手术期间肝脏会出现缺血再灌注损伤，提升交感神经的兴奋性，使机体出现应激反应，增加心肌的耗氧量，最终会使术中麻醉风险大大增加，对患者的手术效果和预后产生不利影响[1-2]。因此，如何减轻围麻醉期的应激反应，减少肝脏的缺血再灌注受损，降低麻醉及镇痛药用量，确保麻醉过程稳定意义重大。经研究证实[3-4]，右美托咪定有着抑制交感活性、维持围术期血流动力学稳定与减少炎性应激反应等多种作用，同时不会明显抑制呼吸系统，可对肝脏的缺血再灌注受损发挥良好保护作用。……