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