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目的探讨七氟烷复合右美托咪啶吸入全身麻醉在食管癌手术中的应用和对苏醒拔管期各项指标的影响。方法选取广东省梅州市人民医院自2013年12月至2015年12月收治的90例食管癌手术患者,按照随机数字表法随机分为对照组和观察组,每组45例。两组患者均给予七氟烷进行麻醉维持,麻醉诱导前,观察组给予0.5μg/kg的右美托咪定稀释至10 ml给予微量泵输注泵输注;对照组给予相同剂量的生理盐水,输注方式同观察组,并于10 min内输注完毕。比较两组患者中心静脉压(MAP)、心率(HR)、苏醒时间、Ramsay镇静评分、躁动评分和焦虑评分(SAS)。结果观察组患者T1、T2及T3时刻HR较T0时刻明显降低,对照组T3时刻的HR和MAP较T1、T2时刻明显提高,观察组患者T1、T2、T3时刻的HR和T3时刻的MAP较对照组低,差异有统计学意义(P<0.05)。观察组患者苏醒时间比对照组缩短,Ramsay镇静评分、躁动评分和SAS评分均比对照组降低,差异有统计学意义(P<0.05)。结论于七氟烷全麻基础上加用右美托咪定应用于食管癌手术吸入全身麻醉过程中,可确保心血管的稳定性,并可缩短苏醒时间,维持镇静,减少苏醒期躁动和焦虑。
Objective To investigate the application of sevoflurane combined dexmedetomidine inhalation and general anesthesia in esophageal cancer surgery and its effect on various indexes during wakeful extubation. Methods 90 patients with esophageal cancer who were treated in Meizhou People’s Hospital of Guangdong Province from December 2013 to December 2015 were randomly divided into control group and observation group according to random number table method, with 45 cases in each group. Both groups were given sevoflurane anesthesia maintenance before induction of anesthesia, the observation group given dexmedetomidine 0.5μg / kg diluted to 10 ml was given a small pump infusion pump; the control group was given the same dose of saline , Infusion mode with the observation group, and within 10 min infusion completed. Central venous pressure (MAP), heart rate (HR), recovery time, Ramsay sedation score, restlessness score and anxiety score (SAS) were compared between the two groups. Results HR in observation group at T1, T2 and T3 was significantly lower than that at T0, and HR and MAP in control group at T3 were significantly higher than those at T1 and T2. HR in observation group at T1, T2, T3 and MAP at T3 The control group was low, the difference was statistically significant (P <0.05). The recovery time of patients in the observation group was shorter than that in the control group. The scores of Ramsay sedation, restlessness and SAS were lower than those of the control group (P <0.05). Conclusion The application of dexmedetomidine combined with sevoflurane anesthesia in the general anesthesia of esophageal cancer during surgical inhalation can ensure the stability of cardiovascular system and shorten the recovery time, maintain the sedation and reduce the restlessness and anxiety .