右美托咪定复合全身麻醉在老年高血压肺癌患者胸腔镜根治术中的效果分析

The effects of dexmedetomidine combined with general anesthesia in thoracoscopic radical resection of lung cancer in the elderly patients with hypertension and lung cancer

摘要:

目的 探讨右美托咪定复合全身麻醉在老年高血压肺癌患者胸腔镜根治术中的应用效果。 方法 选取2016 年7 月—2019 年2 月在徐州市中心医院行胸腔镜根治术的老年高血压肺癌患者96 例作为研究 对象，采用随机数字表法分为实验组与对照组，每组48 例。在麻醉诱导前30 min（T1），实验组静脉注射右 美托咪定，对照组给予等体积的生理盐水。比较T1、麻醉诱导时（T2）、气管插管前（T3）、插管后即刻（T4） 及手术30 min（T5）的心率（HR）、收缩压（SBP）及舒张压（DBP），并比较疼痛视觉模拟评分（VAS）、舒适度评 分（BCS）和术后48 h内镇痛泵按压次数、使用其他镇痛药物率及药物不良反应。结果 实验组与对照组T1、 T2、T3、T4、T5时的HR、SBP及DBP比较，在不同时间、不同组间及变化趋势上有差异（P <0.05）。对照 组T1、T2及T4 的HR、SBP及DBP比较有差异（P <0.05）。实验组与对照组术前2 h 及术后2 h、6 h、12 h、 24 h、48 h 的VAS 评分和BCS 评分比较，在不同时间、不同组间及变化趋势上有差异（P <0.05）。实验组术 后48 h内镇痛泵按压次数少于对照组（P <0.05），且曲马多使用率低于对照组（P <0.05）；两组药物不良反应 发生率比较，差异无统计学意义（P >0.05）。结论 对行胸腔镜根治术的老年高血压肺癌患者采用右美托咪 定复合全身麻醉，可维持插管及术中的血流动力学稳定，减轻术后早期疼痛，减少疼痛药物的使用，提高患 者舒适度，且具有一定的安全性。

Abstract:

Objective To explore the effects of dexmedetomidine combined with general anesthesia in thoracoscopic radical resection of lung cancer in the elderly patients with hypertension and lung cancer. Methods A total of 96 elderly patients with hypertension and lung cancer undergoing thoracoscopic radical resection of lung cancer in our hospital from July 2016 to February 2019 were randomly divided into routine group and research group, with 48 cases in each group. The research group was given dexmedetomidine intravenously 30 minutes before anesthesia induction (T1), while the routine group was given the same volume of normal saline. The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1, anesthesia induction (T2), before endotracheal intubation (T3), immediately after endotracheal intubation (T4), and 30 minutes after operation (T5) were compared. We also analyzed the scores of visual analogue scale (VAS) and Bruggrmann comfort scale (BCS); pressing times of analgesic pump and the rate of using other analgesics within 48 hours after operation; and the occurrence of adverse drug reactions. Results The HR, SBP and DBP were different between the two groups and altered at different time points (T1, T2, T3, T4, T5) with distinct changing trends (P < 0.05). The HR, SBP and DBP were different at T1, T2 and T4 in routine group (P < 0.05). The scores of VAS and BCS were different between the two groups and altered at 2 h before operation as well as 2 h, 6 h, 12 h, 24 h and 48 h after operation with distinct changing trends (P < 0.05). The pressing times of analgesic pump within 48 h after operation in the research group were less than those in the routine group, and the rate of tramadol use in the research group within 48 h after operation was lower than that in the routine group (P < 0.05). There was no significant difference in the overall incidence of adverse drug reactions between the two groups (P > 0.05). Conclusions In the elderly patients with hypertension and lung cancer undergoing thoracoscopic radical resection of lung cancer, dexmedetomidine combined with general anesthesia can to some extent safely maintain hemodynamic stability during intubation and operation, alleviate early postoperative pain, reduce the use of analgesics and improve patient comfort.