吉林大学学报(医学版) ›› 2022, Vol. 48 ›› Issue (5): 1305-1313.doi: 10.13481/j.1671-587X.20220526

• 临床研究 • 上一篇    

右美托咪定持续输注对肿瘤细胞减灭术联合腹腔热灌注化疗患者乳酸代谢和术后康复的影响

张静,王劭恒,刘鹏飞,关雷()   

  1. 首都医科大学附属北京世纪坛医院麻醉科,北京 100038
  • 收稿日期:2021-12-21 出版日期:2022-09-28 发布日期:2022-11-15
  • 通讯作者: 关雷 E-mail:willqun1@sina.com
  • 作者简介:张 静(1984-),女,山东省济南市人,主治医师,医学硕士,主要从事临床麻醉管理方面的研究。
  • 基金资助:
    北京市科委首都特色研究项目(Z161100000516158)

Effects of continuous infusion of dexmedetomidine on lactate metabolism and postoperative recovery in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy

Jing ZHANG,Shaoheng WANG,Pengfei LIU,Lei. GUAN()   

  1. Department of Aneasthesiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
  • Received:2021-12-21 Online:2022-09-28 Published:2022-11-15
  • Contact: Lei. GUAN E-mail:willqun1@sina.com

摘要:

目的 探讨右美托咪定持续输注对择期行肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗术(HIPEC)腹膜癌患者围术期应激反应、乳酸(Lac)清除率和术后康复的影响。 方法 收集60例全身麻醉下行CRS联合HIPEC腹膜癌患者的临床资料,筛选后剔除4例患者,分为对照组(常规麻醉)27例和右美托咪定组29例。所有患者常规全身麻醉,右美托咪定组患者同时给予右美托咪定;术中监测有创动脉压(ABP)和中心静脉压(CVP),测定心脏指数(CI),计算心率血压乘积(RPP),术中以每搏变异度(SVV)指导补液。记录手术前(T0)、HIPEC开始前(T1)、HIPEC结束后(T2)和手术结束后(T3)时平均动脉压(MAP)、心率(HR)、RPP、CVP及CI和血中Lac、碱剩余(BE)、血糖(Glu)和皮质醇水平,计算Lac清除率;记录2组患者术后3 d内并发症发生情况。 结果 循环相关指标,在T0时2组患者MAP、HR、RPP、CVP和CI比较差异无统计学意义(P>0.05);在T1时,与对照组比较,右美托咪定组患者RPP减少(P<0.05);在T2时,与对照组比较,右美托咪定组患者HR和CVP均明显降低(P<0.05),RPP减少(P<0.05);在T3时,与对照组比较,右美托咪定组患者HR、MAP和CVP明显降低(P<0.05),RPP减少(P<0.05),2组患者CI比较差异无统计学意义(P>0.05)。血气及应激相关指标,在T0时,2组患者血中Lac、BE、Glu和皮质醇水平比较差异无统计学意义(P>0.05);在T1和T2时,与对照组比较,右美托咪定组患者血中Lac、Glu和皮质醇水平降低(P<0.05),BE负值减少(P<0.05)。术后Lac水平和肝肾功能,在术后12 h(T4)、术后24 h(T5)、术后48 h(T6)和术后72 h(T7)时,与对照组比较,右美托咪定组患者Lac水平降低(P<0.05),Lac清除率明显升高(P<0.05);T5和T7时右美托咪定组患者丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平明显降低(P<0.05)。术后并发症发生情况,与对照组比较,术后3 d内右美托咪定组患者术后低血压、恶心呕吐、腹胀、寒战和睡眠障碍发生例数明显减少(P<0.05)。 结论 术中右美托咪定持续输注可降低腹膜癌患者围术期应激反应和Lac水平,减少术后并发症发生,促进患者术后康复。

关键词: 右美托咪定, 腹膜肿瘤, 热灌注化疗, 乳酸, 应激反应

Abstract:

Objective To investigate the effects of continuous infusion of dexmedetomidine on the perioperative stress response, lactate(Lac) clearance rate and postoperative rehabilitation of the patients with peritoneal cancer undergoing selective cytoreductive surgery(CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods The clinical data of 60 patients with peritoneal cancer underwent CRS combined with HIPEC under general anesthesia were collected.After screening,4 cases of patients were eliminated; the patients were divided into control group (general anesthesia)(27 patients) and dexmedetomidine group(29 patients). All patients were subjected to general anesthesia,and the patients in dexmedetomidine group recieved dexmedetomidine at the same time. Intraoperative invasive arterial blood pressure (ABP) and central venous pressure (CVP) were monitored, cardiac index (CI) was measured, rate pressure product (RPP) were calculated, and intraoperative fluid replacement was guided by stroke volume variation (SVV). Mean arterial pressure (MAP), heart rate(HR), RPP,CVP and CI were recorded before surgery (T0), before the start of thermoperfusion chemotherapy (T1), after thermoperfusion chemotherapy (T2), and after surgery (T3),and the levels of Lac, base excess (BE),blood glucose (Glu) and cortisol in blood were calculated and Lac dearance rate was calculated. The postoperative complications within 3 d after surgery of the patients between two groups were recorded. Results There were no statistically significant differences in circulatory indicators such as MAP, HR,RPP, CVP and CI between two groups at T0 (P>0.05).At T1,compared with control group,RPP of the patients in dexmedetomidine group was decreased(P<0.05). At T2, compared with control group, HR and CVP of the patients in dexmedetomidine group were significantly decreased (P<0.05), and RPP was decreased (P<0.05).At T3,compared with control group,HR,MAP and CVP of the patients in dexmedetomidine group were significantly decreased (P<0.05),RPP was decreased (P<0.05);there was no significant difference in CI between two groups (P>0.05). At T0, there were no significant differences in the levels of Lac, BE, Glu and cortisol in blood of the patients between two groups (P>0.05). At T1 and T2, compared with control group,the Lac, Glu and cortisol levels in blood of the patients in dexmedetomidine group were decreased (P<0.05), and BE negative value was decreased (P<0.05). At 12 h after surgery(T4), 24 h after surgery(T5), 48 h after surgery(T6) and 72 h after surgery(T7), compared with control group,the Lac levels of the patients in dexmedetomidine group were decreased (P<0.05), and the Lac clearance rates were significantly increased (P<0.05);and the levels of alanine aminotrasferase(ALT) and aspartate aminotransferase(AST) were significantly decreased at T5 and T7 (P<0.05).Compared with control group, the incidence cases of postoperative hypotension, nausea and vomiting, abdominal distention, chills and sleep disorders of the patients in dexmedetomidine group were significantly reduced at 3 d after surgery(P<0.05). Conclusion Intraoperative dexmedetomidine continuous infusion can reduce the perioperative stress response and Lac levels, reduce the incidence of postoperative complications, and promote postoperative recovery in the patients with peritoneal cancer.

Key words: Dexmedetomidine, Peritoneal carcinoma, Hyperthermic intraperitoneal chemotherapy, Lacate, Stress response

中图分类号: 

  • R45