右美托咪定联合酮咯酸氨丁三醇麻醉在腹腔镜胆囊切除术中的应用效果分析

Analysis of the efficacy of dexmedetomidine combined with ketorolac tromethamine anesthesia in laparoscopic cholecystectomy

摘要:

目的 分析右美托咪定与酮咯酸氨丁三醇联合应用于腹腔镜胆囊切除术（LC）的麻醉效果。方法 选取2018年1月－2020年1月该院行LC的患者120例，随机分为对照组（60例）和观察组（60例）。手术过程中，对照组给予酮咯酸氨丁三醇超前镇痛，观察组给予右美托咪定联合酮咯酸氨丁三醇超前镇痛。比较两组患者不同时间点心率（HR）、平均动脉压（MAP）、镇痛评分、镇静评分、氧化应激情况及不良反应。结果 切胆时（T₂），两组患者HR和MAP水平均明显低于术前（T₁）（P < 0.05），观察组HR和MAP水平明显高于对照组（P < 0.05）；气管拔管时（T₃），对照组HR和MAP水平明显高于T₁时点（P < 0.05），观察组HR和MAP水平明显低于对照组（P < 0.05）。术后6 h（T₅）和12 h（T₆），两组患者Ramsay评分均明显高于术后1 h（T₄）（P < 0.05）；T₄、T₅和T₆时点，观察组Ramsay评分明显高于对照组（P < 0.05），数字分级评分（NRS）的动态评分明显低于对照组（P < 0.05）。T₅时点，两组患者血清丙二醛（MDA）和超氧化物歧化酶（SOD）水平均明显高于T₁时点（P < 0.05），总抗氧化能力（T-AOC）水平明显低于T₁时点（P < 0.05），且观察组SOD和T-AOC水平明显高于对照组（P < 0.05），MDA水平明显低于对照组（P < 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P = 0.648）。结论 在酮咯酸氨丁三醇基础上辅以右美托咪定超前镇痛，有助于提高镇痛镇静效果，纠正LC患者机体血流动力学紊乱，控制机体氧化应激反应，且安全性较高。

Abstract:

Objective To analyse the anesthetic effect of dexmedetomidine combined with ketorolac tromethamine anesthesia in laparoscopic cholecystectomy (LC).Methods From January 2018 to January 2020, 120 patients underwent LC were selected, and they were randomly divided into control group (60 cases) and observation group (60 cases). During the operation of the two groups, the control group was given ketorolac tromethamine for preemptive analgesia, and the observation group was given dexmedetomidine combined with ketorolac tromethamine for preemptive analgesia. The heart rate (HR), mean arterial pressure (MAP), analgesia score, sedation scores, oxidative stress at different times and occurrence of adverse reactions of both groups were compared.Results At the time of bile excision (T₂), HR and MAP levels of two groups were significant lower than those before surgery (T₁) (P < 0.05), and HR and MAP levels of observation group were significant higher than those of control group (P < 0.05); At the time of tracheal extubation (T₃), HR and MAP levels of control group were significant higher than those at T₁ (P < 0.05), and HR and MAP levels of observation group were significant lower than those of control group (P < 0.05). At 6 h (T₅) and 12 h (T₆) after surgery, the Ramsay scores of two groups were significant higher than those at 1 h (T₄) after surgery (P < 0.05); At T₄, T₅, and T₆, the Ramsay scores of the observation group were significant higher than those of control group (P < 0.05), and dynamic scoring of numerical rating scale (NRS) of the observation group were significant lower than those of control group (P < 0.05). At T₅, the serum levels of malondialdehyde (MDA) and superoxide dismutase (SOD) of two groups were significant higher than those at T₁ (P < 0.05), the total antioxidant capacity (T-AOC) was significant lower than that at T₁ (P < 0.05), and the SOD and T-AOC levels of observation group were significant higher than those of control group (P < 0.05), and the level of MDA was significant lower than that of control group (P < 0.05). The occurrence of adverse reactions between the two groups was not obviously difference (P = 0.648).Conclusion On the basis of ketorolac tromethamine, supplemented by dexmedetomidine preemptive analgesia, it helps to improve the analgesic and sedative effects, correct the body hemodynamic disorders in patients undergoing LC, control the body oxidative stress response, and has certain safety.