摘要
背景腹腔镜胃癌根治术在胃癌治疗中应用广泛,但患者术后多伴中重度疼痛.以往术后镇痛多依赖阿片类药物,其不良反应明显,且全麻易诱发认知功能障碍.联合右美托咪定可增强镇痛效应、减少认知功能损害,有利于促进预后恢复.目的探讨右美托咪定静脉自控镇痛(patient controlled intravenousanalgesia,PCIA)联合静吸复合麻醉对胃癌患者术后48 h麻醉药物使用情况及早期认知功能的影响.方法选取2021-05/2024-03于我院择期拟行腹腔镜胃癌根治术的胃癌患者206例,按随机数字表法分为对照组(n=103)、研究组(n=103).两组术后均行PCIA,对照组泵注枸橼酸舒芬太尼、盐酸托烷司琼,研究组泵注枸橼酸舒芬太尼、盐酸托烷司琼、右美托咪定.比较两组术后不同时间点平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(oxygen saturation,SpO2)、镇痛评分[视觉模拟量表(visual analogue scale,VAS)评分]、镇静评分[拉姆齐(Ramsay)镇静评分]、早期认知功能[蒙特利尔认知评估量表(Montreal Cognitive Assessment Scale,MoCA)评分、简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)评分]、血清相关因子[白介素-6(interleukin 6,IL-6)、高迁移率族蛋白B1(high mobility group box 1 protein,HMGB1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]及术后48 h麻醉药物使用情况、不良反应发生率.结果研究组术后2 h-48 h MAP、HR低于对照组,差异有统计学意义(P<0.05);研究组术后12 h-48 h VAS评分低于对照组,MMSE、MoCA评分高于对照组,差异有统计学意义(P<0.05);研究组术后24 h、48 h IL-6、TNF-α、HMGB1低于对照组,差异有统计学意义(P<0.05);研究组术后48 h内PCIA按压次数低于对照组,差异有统计学意义(P<0.05);两组术后2 h-48 h SpO2,术后2 h-48 hRamsay评分及不良反应发生率比较,差异无统计学意义.结论右美托咪定PCIA联合静吸复合麻醉可有效缓解胃癌患者术后48 h内疼痛,维持循环稳定,减轻术后认知功能障碍程度、炎症反应损伤,减少术后PCIA按压次数,安全性可靠.
BACKGROUND Laparoscopic radical gastrectomy is widely used in the treatment of gastric cancer,but patients often experience moderate to severe pain after surgery.In the past,postope-rative analgesia mostly relied on opioids,which have significant adverse reactions and easily induce cognitive dysfunction during general anesthesia.When combined with dexmedetomidine,they can enhance analgesic effect,reduce cognitive impairment,and promote patient recovery.AIM To investigate the effects of dexmedetomidine patient-controlled intravenous analgesia(PCIA)with dexmedeto-midine in combination with inhalation-intravenous combined anesthesia on early cognitive function in patients with gastric cancer undergoing laparoscopic radical gastrectomy.METHODS A total of 206 patients with gastric cancer who were scheduled to undergo laparoscopic radical gastrectomy in our hospital from May 2021 to March 2024 were selected.They were divided into a control group(n=103)and a study group(n=103)using the random number table method.Both groups underwent PCIA after surgery.The control group additionally received pump injections of sufentanil citrate and tropisetron hydrochloride,while the study group additionally received pump injections of sufentanil citrate,tropisetron hydrochloride,and dexmedetomidine.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2),analgesia score[visual analog scale(VAS)score],sedation score[Ramsay sedation scale],early cognitive function[Montreal Cognitive Assessment Scale(MoCA)score and mini-mental state examination(MMSE)score],and serum factors[interleukin-6(IL-6),high mobility group box 1 protein(HMGB1),and tumor necrosis factor-α(TNF-α)]at different time points after surgery,as well as anesthesia drug use within 48 hours after surgery and adverse reaction rate,were compared between the two groups.RESULTS The MAP and HR of the study group were significantly lower than those of the control group from 2 to 48 hours after surgery(P<0.05).The VAS scores of the study group were significantly lower than those of the control group from 12 to 48 hours after surgery(P<0.05),while the MMSE and MoCA scores were significantly higher than those of the control group(P<0.05).The levels of IL-6,TNF-α,and HMGB1 in the study group were significantly lower than those in the control group at 24 and 48 hours after surgery(P<0.05).The number of PCIA pump compressions in the study group was significantly lower than that of the control group within 48 hours after surgery(P<0.05).There was no significant difference in SpO2,Ramsay score,or the incidence of adverse reactions between the two groups from 2 to 48 hours after surgery(P>0.05).CONCLUSION PCIA with dexmedetomidine in combination with inhala-tion-intravenous combined anesthesia can effectively relieve pain within 48 h after surgery in patients with gastric cancer,maintain circulation stability,reduce the degree of postoperative cognitive dysfunction,decrease inflammatory injury,and reduce the number of postoperative PCIA pump compressions,suggesting that this combined anesthesia regimen is safe and reliable.
作者
王敏
陈琴
项云
Min Wang;Qin Chen;Yun Xiang(Department of Anesthesio-logy,Lishui People’s Hospital,Lishui 323000,Zhejiang Province,China)
出处
《世界华人消化杂志》
2025年第1期53-61,共9页
World Chinese Journal of Digestology
关键词
胃癌
右美托咪定
静脉自控镇痛
镇静效果
认知功能
Gastric cancer
Dexmedetomidine
Patient-controlled intravenous analgesia
Sedative effect
Cognitive function
作者简介
王敏,中级主治医师,研究方向为麻醉学;通讯作者:王敏,中级主治医师,323000,浙江省丽水市大众街15号(府前院区),丽水市人民医院麻醉科.xieqian9969704074@163.com。
