| Purpose: In the process of gastric cancer patients undergoing radical gastric cancer combined with intraperitoneal hyperthermic perfusion chemotherapy,surgical trauma and postoperative pain can stimulate sympathetic nerves,inhibit intestinal smooth muscle contraction,delay gastrointestinal emptying,and affect the recovery of intestinal function.In the intraperitoneal hyperthermic perfusion chemotherapy,the intestinal tissue is soaked in high-temperature liquid for a long time and is mechanically washed by the liquid,which will cause complications such as intestinal paralysis and intestinal tissue edema,and destroy the beneficial flora of the gastrointestinal tract in the patient.Balance seriously affects the recovery of intestinal function after surgery.Lidocaine is a commonly used amide local anesthetic.Intravenous infusion of lidocaine can not only have analgesic effect,but also can directly excite the smooth muscle of the intestine and enhance the contraction ability of the intestinal muscle by blocking the inner inhibitory nerve regulation of the intestine.;Dexmedetomidine produces sedation,analgesia and anti-inflammatory effects by stimulating α 2 adrenergic receptors.These effects have been confirmed in various clinical trials.but The effect of lidocaine combined with intravenous infusion of dexmedetomidine on the recovery of intestinal function in patients undergoing radical gastrectomy combined with intraoperative intraperitoneal hyperthermic perfusion chemotherapy has not been confirmed by experiments.In this study,patients with radical gastric cancer combined with intraoperative intraperitoneal hyperthermic perfusion chemotherapy were injected with lidocaine combined with dexmedetomidine,and the serum D-lactic acid content before and 6h after operation and the time of first ventilation and defecation after operation were observed and recorded.,To explore the effects of the two drugs on the intestinal function of patients after surgery,aiming to achieve the purpose of promoting rapid recovery of patients after surgery.Methods 80 patients who underwent elective radical gastrectomy combined with intraoperative intraperitoneal hyperthermic infusion chemotherapy were randomly divided into lidocaine group(L group),dexmedetomidine group(D group),and lidocaine combined with dextromethorphan Detomidine group(LD group)and control group(group C),20 cases in each group;loading doses of lidocaine,dexmedetomidine,lidocaine combined with dexmedetomidine and dexmedetomidine were injected 10 minutes before induction of anesthesia With equal volume of normal saline,the maintenance dose was pumped continuously until 15 minutes after the start of perfusion.Detect the serum D-lactic acid content of all patients 6h before and 6h after operation,and record the time of induction of anesthesia(T1),start of perfusion(T2),end of perfusion(T3),6h after operation(T4),and operation in each group.Mean arterial pressure and heart rate after 24h(T5),anesthesia time,operation time,recovery time,extubation time,remifentanil dose,PCIA compressions,first intestinal ventilation time,defecation time and hospital stay;6h after operation,12 h after operation,18 h after operation,24 h after operation,48 h after operation(analogue scale to evaluate the pain score;Ramsay sedation score 1min after extubation,5min after extubation,15 min after extubation,30 min after extubationResults There was no statistically significant difference in the general conditions of the four groups of patients;the serum D-lactic acid content of the four groups of patients 6h after surgery was higher than that of the 6h before surgery(P<0.05);compared with group C,group L,LD The serum D-lactic acid content of patients in the LD group was significantly reduced at 6 hours after surgery(P<0.05),and the serum D-lactic acid content of patients in the LD group was the lowest at 6hours after surgery(P<0.05).Compared with group C,group D and group L,the heart rate and mean arterial pressure values ??of patients in LD group decreased at T2,T3,T4,and T5(P<0.05).Compared with group C,the time of first exhaust and defecation after operation were significantly shortened for patients in group L and LD(P<0.05);the hospital stay in group LD was also shortened.Compared with group C,group D,and group L,patients in LD group had significantly lower VAS scores within 48 hours after surgery,and higher RSS scores within 20 minutes after extubation(P<0.05);compared with group C,group D and group LD The number of times of intravenous self-controlled analgesia pump was reduced(P < 0.05).Compared with group C,the dosage of propofol and remifentanil in group L,group D and LD group was significantly reduced(P<0.05).Conclusion Lidocaine combined with intravenous infusion of dexmedetomidine can promote the recovery of intestinal function in patients with radical gastric cancer combined with intraoperative intraperitoneal hyperthermic perfusion chemotherapy,and shorten the patient’s hospital stay. |
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