右美托咪啶对开腹胃癌根治术中 肠系膜牵拉综合征的影响

Effect of Dexmedetomidine on mesenteric traction syndrome during radical gastrectomy

摘要:

目的 探讨右美托咪啶对开腹胃癌根治术中肠系膜牵拉综合征（MTS）的影响。方法 60 例拟行 全身麻醉下开腹胃癌根治术的患者随机分为右美托咪啶组（Dex 组）和对照组（Con 组）。Dex 组在麻醉诱导 前10 min 泵注右美托咪啶0.5μg/kg 后以0.5 μg/（kg·h）的速率维持，Con 组给予生理盐水。手术在丙泊 酚和瑞芬太尼全凭静脉麻醉下完成。以腹腔打开后30 min 内是否出现面部潮红来判断有无发生MTS，记录 MTS 患者出现面色潮红后低血压的发生率、持续时间及去氧肾上腺素使用量，监测MTS 患者基础（T1）、腹 腔打开即刻（T2）、打开后10 min（T3）、20 min（T4）和30 min（T5）的收缩压和心率。结果 Con 组和Dex 组 各有15 和17 例患者术中出现MTS，发生率分别为52% 和57%，两组比较差异无统计学意义（P >0.05）。Dex 组MTS 患者出现面色潮红后低血压持续时间和去氧肾上腺素使用量与Con 组比较，差异有统计学意义（P < 0.05），Dex 组大于Con 组。Dex 组MTS 患者T3 时的收缩压与Con 组比较，差异有统计学意义（P <0.01），Dex 组低于Con 组。Dex 组MTS 患者T2、T3 和T5 时的心率与Con 组比较，差异有统计学意义（P <0.05），Dex 组 低于Con 组。结论 右美托咪啶对开腹胃癌根治术MTS 的发生率没有影响，但能加重MTS 时的低血压。

Abstract:

Objective To explore the effect of Dexmedetomidine on mesenteric traction syndrome (MTS) during radical gastrectomy. Methods Sixty patients scheduled for radical gastrectomy under general anesthesia were randomly allocated to a Dexmedetomidine group and a control group. Dexmedetomidine 0.5 μg/kg was intravenously infused 10 min before anesthesia induction, followed by a continuous infusion at the rate of 0.5 μg/(kg?h) in the Dexmedetomidine group, and saline was administrated in the control group. Radical gastrectomy was performed under total intravenous anesthesia with Propofol and Remifentanil. MTS was diagnosed by a single symptom of facial flushing within 30 min following opening of the abdomen. The incidence and duration of hypotension and the dosage of phenylephrine were recorded. The systolic blood pressure and heart rate in the patients with MTS were monitored before operation (T1), at the moment of opening the abdomen (T2), 10 (T3), 20 (T4) and 30 min (T5) after opening of the abdomen. Results The incidence of MTS was 52% in the control group and 57% in the Dexmedetomidine group, there was no significant difference between the two groups (P > 0.05). The duration of hypotension in the patients with MTS of the Dexmedetomidine group was significantly longer than that of the control group, and the dosage of phenylephrine was significantly increased in the patients with MTS of the Dexmedetomidine group as compared with that of the control group (P < 0.05). The systolic blood pressure in the patients with MTS of the Dexmedetomidine group was significantly lower than that of the control group at T3 (P < 0.05). At T2, T3 and T5, the heart rate in the patients with MTS of the Dexmedetomidine group was significantly decreased as compared with that of the control group (P < 0.05). Conclusions Dexmedetomidine has no influence of the incidence on MTS, but can make hypotension more serious.