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目的:探讨全麻下行胰腺癌高强度聚焦超声(HIFU)治疗中应用右美托咪啶的临床价值。方法:选取2014年4月—2015年12月行HIFU手术治疗的87例胰腺癌患者采用抽签法随机分为观察组43例和对照组44例,两组均采用芬太尼2~3μg/kg、顺阿曲库铵0.2 mg/kg、丙泊酚1.5~2.0 mg/kg进行麻醉诱导,采用丙泊酚、雷米芬太尼、顺阿曲库铵、七氟烷进行维持麻醉,观察组于麻醉诱导前15 min静脉输注右美托咪啶负荷量0.7μg/kg,之后以0.2μg/(kg·h)静脉输注至术毕,对照组麻醉诱导前给予等量生理盐水。比较两组患者麻醉诱导完毕(T_0)、麻醉30 min(T1)、麻醉90 min(T_2)、麻醉180 min(T3)时刻的平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(SpO_2)水平,以及麻醉前、手术后90 min的血清炎症因子的变化。结果:观察组的丙泊酚用量、七氟烷用量、雷米芬太尼用量均明显低于对照组(均P<0.05);观察组和对照组的手术时间、麻醉时间、拔管时间差异均无统计学意义(均P>0.05);在T0~T3时刻,两组患者的MAP值差异均无统计学意义(P>0.05);在T1~T3时刻,观察组的HR值明显低于对照组,而SpO_2值明显高于对照组(均P<0.05);术前两组各炎症因子水平差异均无统计学意义(均P>0.05);术毕90 min,观察组各炎症因子水平均明显低于对照组(均P<0.05)。结论:全麻下行胰腺癌HIFU治疗中应用右美托咪啶可以减少麻醉药物的用量、稳定术中心率、降低炎症因子水平。
Objective: To investigate the clinical value of dexmedetomidine in high intensity focused ultrasound (HIFU) treatment of pancreatic cancer under general anesthesia. METHODS: A total of 87 pancreatic cancer patients who underwent HIFU surgery between April 2014 and December 2015 were randomized into 43 patients in the observation group and 44 in the control group. Both groups used fentanyl 2~3 μg/kg. , Cisaccurium 0.2 mg/kg, Propofol 1.5~2.0 mg/kg for induction of anesthesia, Propofol, Remifentanil, Citracurium, Sevoflurane for maintenance anesthesia, Observation group Intravenous infusion of dexmedetomidine 0.5μg/kg intravenously for 15 min before induction of anesthesia, followed by 0.2μg/(kg·h) intravenous infusion to the end of surgery, the control group was given an equal amount of normal saline before induction of anesthesia. The mean arterial pressure (MAP), heart rate (HR), and arterial oxygen saturation at the time of anesthesia induction (T_0), 30 min (T1) anesthesia, 90 min (T_2) anesthesia, and 180 min (T3) anesthesia were compared between the two groups. (SpO 2 ) levels, and changes in serum inflammatory factors 90 min before and after anesthesia. RESULTS: The propofol dose, sevoflurane dose, and remifentanil dose in the observation group were significantly lower than those in the control group (all P<0.05); the differences in the operation time, anesthesia time, and extubation time between the observation group and the control group were different. There was no statistical significance (all P>0.05). At T0~T3, there was no significant difference in MAP values between the two groups (P>0.05). At T1~T3, the HR of the observation group was significantly lower than that of the other two groups. In the control group, the SpO2 value was significantly higher than that in the control group (all P<0.05); there was no significant difference in the levels of inflammatory factors between the two groups before surgery (all P>0.05); after 90 minutes of operation, the levels of inflammatory factors in the observation group were observed. All were significantly lower than the control group (all P<0.05). Conclusion: The application of dexmedetomidine in the treatment of pancreatic cancer with HIFU under general anesthesia can reduce the dosage of anesthetic drugs, stabilize the center rate of surgery, and reduce the level of inflammatory factors.