ABSTRACT
Objective:To compare the effects of dexmedetomidine combined with propofol on anesthesia and thromboelastography in patients undergoing radical gastrectomy.Methods:From September 2017 to December 2019, 120 patients undergoing radical gastrectomy in Chaoyang Central Hospital were prospectively selected and divided into control group and observation group according to random number table method, with 60 cases in each group.The two groups used the same drugs before induction and the same way of anesthesia induction. During the maintenance of anesthesia, remifentanil and propofol were injected intravenously in the control group, and dexmedetomidine was injected in the observation group on the basis of the control group. The indexes of thromboelastography, preoperative and postoperative cellular immune function, postoperative analgesic effect [Visual Analogue Scale (VAS)], Ramsay sedation score, and postoperative adverse reactions were compared between the two groups at different times.Results:The reaction time of coagulation factor (R) and fibrinogen (K) in the two groups decreased 3 hours after operation, and those in the observation group were lower than those in the control group (all P<0.05); The maximum thrombus amplitude (MA) of the two groups increased 3 hours after operation, and MA in the observation group was higher than that in the control group (all P<0.05). Compared with that before operation, the VAS scores and Ramsay sedation scores in the control group and the observation group at 24 h and 48 h after operation were significantly lower (all P<0.05), and the VAS scores and Ramsay sedation scores in the observation group at 24 h and 48 h after operation were significantly lower than those in the control group (all P<0.05). Compared with that before operation, the CD4 +, CD8 +, CD4 + /CD8 + in the control group and the observation group were improved at 6 h and 48 h after operation (all P<0.05), and the improvement in the observation group was significantly better than that in the control group at 6 h and 48 h after operation (all P<0.05). The incidence of adverse reactions in the control group was 6.67%(4/60), which was slightly higher than that in the observation group of 5.00%(3/60), but the difference was not statistically significant ( P>0.05). Conclusions:Compared with propofol and remifentanil alone, combined application of dexmedetomidine can help patients undergoing radical gastrectomy for gastric cancer to achieve better analgesic effect, improve the blood coagulation state of patients, and play a better regulatory role on cellular immune function, which is worthy of further promotion in clinic.
ABSTRACT
Objective:To study the effect of dexmedetomidine (Dex) combined with sevoflurane anesthesia on postoperative cognitive function and hemodynamics in elderly patients with humeral fractures during the operation.Methods:A total of 120 elderly patients with humeral fractures diagnosed and treated in Chaoyang Central Hospital from January 2018 to June 2020 were selected and divided into the control group (59 cases) and the study group (61 cases) according to the non-randomized clinical concurrent controlled study and patients′ voluntary principle. Sevoflurane inhalation was given to patients to maintain general anesthesia in two groups, while Dex anesthesia was given to the study group. Cognitive function, hemodynamics, stress response and pain were compared between the two groups before and after the operation, and anesthesia related complications were observed and recorded.Results:The mean arterial pressure (MAP) in the study group at 10 min after endotracheal intubation (T 1), operation time (T 2), 30 min after the beginning of the operation (T 3) were lower than those in the control group, the heart rate (HR) in the study group at T 2, T 3 and the immediate time after the operation (T 4) were lower than those in the control group, the differences were statistically significant ( P<0.05). The levels of norepinephrine (NE) and cortisol (Cor) in the study group were lower than those in the control group after the surgery: (0.92 ± 0.19) mmol/L vs. (1.10 ± 0.28) mmol/L, (213.69 ± 20.83) μg/L vs. (258.43 ± 28.27) μg/L, the differences were statistically significant ( P<0.05). The scores of Montreal Cognitive Assessmentin the study group on 3, 7 d after the operation were higher than those in the control group: (23.42 ± 1.37) points vs. (21.39 ± 1.53) points, (25.83 ± 0.95) points vs. (25.14 ± 0.99) points, the differences were statistically significant ( P<0.05). The incidence of anesthesia related complications in the study group was lower than that in the control group: 8.2%(5/61) vs. 22.0%(13/59), χ2 = 4.50, P<0.05. Conclusions:The application of Dex combined with sevoflurane in the anesthesia of elderly patients with humeral fractures is beneficial to maintain hemodynamic stability, reduce stress response and pain degree, and promote the recovery of cognitive function.