摘要
目的评价小剂量右美托咪定对老年直肠癌Dixon手术患者围术期胰岛素抵抗及术后恢复的影响。方法选择2016年3月~2017年6月我院收治的老年开腹直肠癌Dixon手术患者50例,采用随机数字表法将其分为两组,各25例,右美托咪定组(DEX组)麻醉诱导前15 min静脉微泵注射0.5μg/kg右美托咪定,然后以0.2μg/(kg·h)维持至关腹;对照组微泵注射等容量0.9%氯化钠注射液至关腹。于麻醉开始前30 min(T0)、手术开始后1 h(T1)、术后1 h(T2)、术后24 h(T3)采取静脉血样,测定血糖(BG)、胰岛素(INS)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的浓度,计算胰岛素抵抗指数(HOMA-IR),观察两组患者术毕至睁眼时间和术毕至拔管时间,术毕、术后2 h、4 h、8 h、12 h、24 h静息视觉模拟评分(VAS),伯格曼舒适度评分(BCS),围术期芬太尼使用量、术后按压患者静脉自控镇痛泵(PCIA)次数,术后肠道首次排气时间、住院时间。结果与对照组比较,DEX组T1~3时血糖、血清胰岛素、IL-6、TNF-α浓度、HOMA-IR均较低(P<0.05)。两组患者苏醒时间(术毕至睁眼时间和术毕至拔管时间)比较,差异无统计学意义(P>0.05)。DEX组患者术毕、术后2 h、4 h、8 h、12 h VAS疼痛评分均低于对照组(P<0.05),BCS舒适度评分高于对照组(P<0.05),芬太尼使用量、术后24 h PCIA按压次数均少于对照组(P<0.05);DEX组术后肠道首次排气时间及住院时间均较对照组短(P<0.05)。结论小剂量右美托咪定能有效减轻老年直肠癌患者围术期胰岛素抵抗,有利于患者术后恢复。
Objective To evaluate the effect of low-dose dexmedetomidine on perioperative insulin resistance and postoperative recovery in elderly patients with Dixon surgery for rectal cancer treated.Methods Fifty patients with selective Dixon surgery for open rectal cancer from March 2016 to June 2017 were enrolled.They were randomly divided into two groups,each of 25 cases,The dexmedetomidine group was treated with micro pump injection of 0.5μg/kg dexmedetomidine 15 min before anesthesia induction,and then maintained at 0.2μg/(kg·h)until closing the abdomen.The control group was treated with micro pump injection of 0.9%sodium chloride until closing the abdomen.The venous samples(BG)were taken at 30 minutes before the start of anesthesia(T0),1 hour after the start of surgery(T1),1 hour after surgery(T2),and 24 hours after surgery(T3).The concentrations of blood glucose(BG),insulin(INS),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)were detected.And the insulin resistance index(HOMA-IR)was calculated.The time from the end of the operation to the blink of the eye and the time from the end of the operation to the extubation of two groups were observed.The resting visual analogue scale(VAS)and Bergman Comfort Score(BCS)at the end of surgery,2 hours,4 hours,8 hours,12 hours after surgery,and 24 hours after surgery were observed.Perioperative fentanyl use,the number of compressing the intravenousanalgesia pump(PCIA)of paitents,the first exhaust time of the intestine after surgery,and the length of hospital stay were analyzed.Results Compared with that of the control group,the blood glucose,serum insulin,IL-6,TNF-αconcentration and HOMA-IR were lower in the DEX group at T1-T3(P<0.05).There was no significant difference in the recovery time between the two groups(from the end of the operation to the blink of the eye and from the end of the operation to the extubation)(P>0.05).The VAS pain scores of the patients in the DEX group were lower than those in the control group at the end of surgery,2 hours,4 hours,8 hours after surgery,and 12 hours after surgery(P<0.05),and the BCS comfort score was higher than that of the control group(P<0.05).The amount of fentanyl usage and the number of PCIA compressions at 24 hours after operation were lower than those in the control group(P<0.05).The first exhaust time of the intestine and hospitalization time in the DEX group were shorter than those in the control group(P<0.05).Conclusion Low-dose dexmedetomidine can effectively alleviate perioperative insulin resistance in elderly patients with rectal cancer,which is beneficial to postoperative recovery.
作者
李坤旺
冯智英
樊理华
陈苗妙
章玲宾
吴继敏
徐巧敏
游敏吉
LI Kunwang;FENG Zhiying;FAN Lihua;CHEN Miaomiao;ZHANG Lingbin;WU Jimin;XU Qiaomin;YOU Minji(Department of Anesthesiology,Lishui People's Hospital in Zhejiang Province,Lishui,323000,China;Department of Pain Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310003,China;Department of Critical Care Medicine,Lishui People's Hospital in Zhejiang Province,Lishui,323000,China)
出处
《中国现代医生》
2019年第28期125-129,137,共5页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2017ZH029、2019KY799)
浙江省医学会临床科研基金项目(2015ZYCA126)
关键词
右美托咪定
老年
直肠癌根治术
胰岛素抵抗
术后恢复
Dexmedetomidine
Senile
Radical resection of rectal cancer
Insulin resistance
Postoperative recovery
