| 鲁金钢.右美托咪定联合咪达唑仑对胃肠道手术患者血流动力学及肠道功能影响[J].浙江中西医结合杂志,2023,33(2): |
| 右美托咪定联合咪达唑仑对胃肠道手术患者血流动力学及肠道功能影响 |
| Effects of dexmedetomidine and midazolam on hemodynamics and intestinal function in patients undergoing gastrointestinal surgery |
| 投稿时间：2021-11-03 修订日期：2022-03-19 |
| DOI： |
| 中文关键词: 右美托咪定 胃肠道手术 血流动力学 肠道功能 |
| 英文关键词:Dexmedetomidine gastrointestinal surgery hemodynamics intestinal function |
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| 中文摘要: |
| 摘要：目的 探究右美托咪定联合咪达唑仑对胃肠道手术患者血流动力学及肠道功能影响。方法 选取2016年1月到2019年1月于本院行胃肠道手术的患者200例，随机数字表法分为对照组（n=100例）和观察组（n=100例）。观察组麻醉诱导前15min给予0.5μg/kgDEX静脉泵注，气管插管后给予0.5μg/kg/hDEX持续静脉泵注至手术操作结束前30min；对照组给予7ml生理盐水静脉泵注，气管插管后给予10ml/h生理盐水持续静脉泵注至手术操作结束前30min。2组均给予 0. 05 mg/kg咪达唑仑、2 mg/kg丙泊酚、4 μg/kg芬太尼、0. 1 mg/kg维库溴铵，静脉注射麻醉诱导，后接机械通气，调整参数，术中4~8 mg/kg/h丙泊酚、0.1~0.3μg/kg/min瑞芬太尼右颈内静脉持续泵注，间隔30min给予3mg顺式阿曲库铵至手术操作结束。待患者清醒，评估综合状况后方撤气管导管插管，送入监护室。观察两组血流动力学、胃肠道功能、肠道通透性、炎性因子等指标。结果 与术前相比，手术开始、手术1 h、拔管10min对照组HR明显增快（P<0.05）,SBP、MAP明显增高（P<0.05）；手术开始、手术1 h、拔管10min，观察组HR明显慢于对照组（P<0.05），SBP、DBP、MAP低于对照组（P<0.05）。观察组肠鸣音恢复时间、首次排气、排便时间均短于对照组（P<0.05）。2组患者术后D-Lac、DAO较术前降低（P<0.05），观察组术后D-Lac、DAO降低更明显（P<0.05）。2组术后TNF-α明显减少（P<0.05）对照组术后TNF-α升高（P<0.05）；2组IL-6均无明显变化（P＞0.05）。结论 右美托咪定联合咪达唑仑可有效稳定胃肠道手术患者血流动力学波动，促进术后肠道功能的恢复，保护肠道屏障，发挥抗炎作用，具有良好的临床应用前景。 |
| 英文摘要: |
| Abstract: Objective: To investigate the effect of dexmedetomidine combined with midazolam on hemodynamics and intestinal function in patients undergoing gastrointestinal surgery. Methods: A total of 200 patients who underwent gastrointestinal surgery in our hospital from January 2016 to January 2019 were enrolled. The random number table method was divided into control group (n=100 cases) and observation group (n=100 cases). The observation group was given 0.5μg/kgDEX intravenous pump 15min before induction of anesthesia, and 0.5μg/kg/hDEX was given intravenously after endotracheal intubation until 30 minutes before the end of the operation. The control group was given intravenous injection of 7ml saline, tracheal intubation. After 10 ml/h saline was administered intravenously for 30 minutes before the end of the operation. Two groups were given 0.05 mg / kg midazolam, 2 mg / kg propofol, 4 μ g / kg fentanyl, 0.1 mg / kg vecuronium, intravenous anesthesia induction, followed by mechanical ventilation, adjustment of parameters, intraoperative 4-8 mg / kg / h propofol, 0.1-0.3 μ g / kg / min remifentanil right internal jugular vein continuous pump injection, interval 30 minutes to give 3 mg CIS atracurium to the end of the operation. When the patient is awake, the tracheal intubation should be removed and sent to the monitoring room after the comprehensive condition is evaluated. Hemodynamics, gastrointestinal function, intestinal permeability and inflammatory factors were observed. Results: Compared with preoperative, the HR of the control group increased significantly (P<0.05) and SBP and MAP increased significantly (P<0.05). The operation was started, the operation was performed for 1 hour, and the extubation was performed for 10 minutes. The HR of the observation group was significantly slower than that of the control group (P<0.05), and the SBP, DBP and MAP were lower than the control group (P<0.05). The recovery time, first venting and defecation time of the bowel sounds in the observation group were shorter than those in the control group (P<0.05). The D-Lac and DAO of the two groups were lower than those before operation (P<0.05). The decrease of D-Lac and DAO was more obvious in the observation group (P<0.05). After operation, TNF-α was significantly decreased in the 2 groups (P<0.05), and TNF-α was increased in the control group (P<0.05). There was no significant change in IL-6 between the two groups (P>0.05). Conclusion: Dexmedetomidine combined with midazolam can effectively stabilize the hemodynamic fluctuation of patients undergoing gastrointestinal surgery, promote the recovery of intestinal function, protect the intestinal barrier, and play an anti-inflammatory role. |
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