|
Objective: dexmedetomidine given a new generation of highly selective alpha. Adrenergic receptor agonist, has sedative and hypnotic effects of dose-dependent, and can reduce the amount of anesthetic. Α2 receptors in the central nervous system and the outer periphery of the same time by the high selectively excited, having analgesic and sympathetic blockade, inhibition of stress response role. This study is to explore the application of dexmedetomidine given after hormones, cytokines and other stress indicators, as well as the impact of postoperative sleep quality in elderly patients with colorectal cancer surgery; and explore dexmedetomidine given in elderly patients with the clinical application of dose-effect relationship. Methods: 24 cases of colorectal cancer patients, aged 60-80 years old, ASA grade 1-2 level, were randomly divided into the subjects I (control group), II (dexmedetomidine constant load group), III (right the medetomidine load to maintain group) of three groups of eight cases. All patients in the preoperative 30 minutes intramuscular injection of pentobarbital sodium 0.1g, atropine 0.5mg. I using saline 20m1. Ⅱ group before anesthesia pump into the Dex 0.5ug/kg (infusion time of 10min). Group Ⅲ pumped before anesthesia Dex 0.5ug/kg (pump NOTE 10min) and the surgery continued infusion of 0.5 ug / kg h until the abdomen was closed. Anesthesia method endotracheal intubation under general anesthesia. Induction of all patients midazolam 0.04-0.05mg/kg, and fentanyl 5-6ug/kg, vecuronium 0.1-0.15mg/kg, etomidate 0.2-0.25 mg / kg. Maintenance of anesthesia: the first half of surgery based on the need to append the appropriate amount of fentanyl anesthesia. Then anesthesia needed continuing pumped propofol to maintain calm, analgesic remifentanil maintain. Intermittent injection of an appropriate amount of vecuronium requirements to maintain muscle relaxation. Intraoperative auditory evoked potential index (AEPI) to maintain 20-30. The surgery sent anesthesia recovery room to continue to observe the open electronic analgesia pump after extubation. On T1 (before anesthesia, respectively), T2 (10 minutes) after extubation, T-. (After 24 hours), T4 (after 48 hours) time points blood investigations COR, ACTH, GH, BS, IL-1β, IL-6, TNF-α and other indicators. Preoperative and postoperative 48h, respectively before discharge to assess the Pittsburgh Sleep Quality Index. The observed postoperative analgesia in postoperative 24h and 48h Ramsay score, VAS score, vomiting score, and calculate the amount of fentanyl analgesia pump in 48h. Results: (1) three groups of patients age, height, weight, ASA physical status, and BMI, no statistically significant difference (P gt; 0.05). The dosage of fentanyl comparison ② three groups of patients: group Ⅰ (0.90 ± 0.72mg), Ⅱ group (0.71 ± 0.58 mg), Ⅲ group (0.65 ± 0.05mg) decreasing. Ⅱ, Ⅲ group was significantly less than group Ⅰ statistically significant difference (P lt; 0.05) between group Ⅱ and group Ⅲ was no significant difference sex (P gt; 0.05). Three groups intraoperative remifentanil dosage Ⅱ group (1.15 ± 0.74mg), Ⅲ group (1.02 ± 0.70mag) and group I (1.35 ± 0.80mg) there are significant difference (P lt; 0.05), group Ⅱ a group Ⅲ was no significant difference in sex (P gt; 0.05) three groups of postoperative analgesic fentanyl dose there are significantly different sex (P lt; 0.05) group III at least the amount of fentanyl (0.55 ± 0.16mg) , Ⅱ group (0.84 ± 0.19mg), the largest amount of the control group (0.98 ± 0.37mg). Pittsburgh Sleep Quality Index (3) three groups of patients, Ramsay sedation score the VAS, vomiting classification was no significant difference (P gt; 0.05). ④ MAP basis of the value of the three groups of patients no significant differences, the Ⅰ group extubation was significantly higher, and then declining. Ⅱ, Ⅲ group extubation was significantly elevated blood pressure. Ⅰ and group Ⅱ changes in heart rate at various time points the difference was not significant sex (p gt; 0.05). ⑤ three groups of patients stop anesthetics - extubation time was no significant difference between group Ⅱ, Ⅲ group than group Ⅰ extubation - send ward time was significantly longer (P lt; 0.05). ⑥ three groups of patients COR, GH, BS, IL-1β, IL-6, TNF-α group and in each group there was no significant difference in sex (P gt; 0.05). ACTH three groups within the patient group compared the difference was significant (P lt; 0.05), no difference between groups significant sex (P gt; 0.05). Conclusions: 1 The research shows that the use of dexmedetomidine given anesthesia in elderly patients with colorectal surgery can reduce opioid consumption, and effective control of the surgical stress response. 2. Dexmedetomidine given no significant improvement in the quality of sleep after the implementation of colorectal surgery in elderly patients. 3. Dexmedetomidine given as adjuvant drugs in elderly patients with colorectal surgery anesthesia, plus 0.5ug/kg · h 0.5ug/kg loading dose maintenance dose.
|