Observation Of Treatment Effect Of Dexmedetomidine Hydrochloride Combined With Parecoxib Sodium During Perioperative Period In Patients Reciving Abdominal Gastrointestinal Surgery

Objective:To observe the effect of single application of dexmedetomidine hydrochloride or parecoxib sodium,or the combination of the two applications in open gastrointestinal surgery,and to evaluate those effects on patients during perioperative period.Method:Eighty patients undergoing open abdominal surgery under general anesthesia in Department of general surgery of China-Japan Friendship Hospital Affiliated Jilin University from March 2015 to December 2016 were selected,who were ASA I~III,aging 40~70 years old,weighing45~80kg.All patients were randomly divided into four groups,20 cases in each group.After routine anesthesia induction,endotracheal intubation was performed.Combined intravenous-inhalation anesthesia was carried out,and BIS was maintained 40-60 during the operation.A group: Control group(n=20),before induction of 15 min,continually infused 20ml0.9% NaCl solution for 30 min at a rate of 0.7ml/min.30 minutes before the end of surgery,2ml 0.9% NaCl solution intravenous pushed.B group:Dexmedetomidine hydrochloride group(n=20),before induction of 15 min,continually infused 20 ml 0.9% NaCl solution with 0.6ug/kg load of dexmedetomidine for 30 min at a rate of 0.7ml/min.30 min before operation finished,2ml 0.9% NaCl solution intravenous pushed.C group: Parecoxib sodium group(n=20),15 min before induction,continually infused 20ml0.9% NaCl solution for 30 min at a rate of 0.7ml/min.30 min before the end of operation,40 mg parecoxib sodium in 2ml 0.9% NaCl solution intravenous pushed.D group: Dexmedetomidine hydrochloride combined with parecoxib sodium group,(n=20),15 min before induction,continually infused 20 ml 0.9% NaCl solution with 0.6ug/kg load of dexmedetomidine for 30 min at a rate of 0.7ml/min.30 min before the end of operation,40 mg parecoxib sodium in 2ml 0.9% NaCl solution intravenous pushed.After the end of the operation,connected the same proportion of patient-controlled intravenous analgesia pump(PCIA).Observed and recorded the four groups of recovery time(ftom stopping drug to openning eyes),extubation time(from stopping drug to taking out the endotracheal tube),operation time,bleeding volume and urine volume during operation.Evaluated the heart rate(HR)and mean arterial pressure(MAP)at the moment of 5min before the drug pumped(T0),5min after drug pumped(T1),1min after intubation(T2),cutting skin(T3),extubating(T4).Recorded the scores at the time of postoperative 1h(t1),2h(t2),4h(t3),6h(t4),12h(t5),24h(t6),48h(t7)by using visual analogue scale(VAS)and ramsaysedation.Recorded the number of pressing PCIA.Also recorded the cases of postoperative nausea and vomiting,restlessness,dizziness,skin itching,respiratory depression,anastomotic leakage,postoperative bleeding.Results:(1)There were no significant differences in gender,age,weight,recovery time,extubation time,operation time,extubation time,intraoperative blood loss,and urine volume(P>0.05).(2)Cardiovascular response: There were no significant differences in HR and MAP at T0 between the four groups(P>0.05).Compared with T0,T1,B group and D group,HR decreased significantly(P<0.05),but no significant changed in MAP(P>0.05).T2,four groups of patients had a tendency to rise in HR and MAP,especially,A group and C group,which weren't given dexmedetomidine,HR and MAP increased more obviously(P<0.05).B group and D group with dexmedetomidine,HR and MAP fluctuated slightly,the differences were not statistically significant(P>0.05).T4,all patients' HR and MAP increased,but the HR and MAP of A group and B group without parecoxib sodium increased more significantly(P<0.05).(3)Pain score(VAS score)and sedation score(Ramsay sedation score)were significantly higher in B group,C group and D group than in the A group(P<0.01).Compared with B group and C group,the D group wassignificantly lower analgesic score(P<0.05).Compared with A group and C group,B group and D group had higher sedation score(P<0.05).(4)The times of pressing PCIA: Compared with A group,the times of B group,C group and D group were fewer(P<0.05).Compared with B group and C group,the times of D group were fewer(P<0.01).(5)Postoperative adverse reactions: Compared with group A,the number of postoperative restlessness in B,C and D groups decreased significantly(P<0.05).Compared with B group and C group,the number of postoperative agitation were lower in D group.There were no significant differences in the incidence of other adverse reactions between the four groups(P>0.05).Conclusions:1.Whether single or combined application of dexmedetomidine hydrochloride and parecoxib sodium in open gastrointestinal surgery,both can alleviate the postoperative pain,reduce the dosage of PCIA.2.Combined application of dexmedetomidine hydrochloride and parecoxib sodium,the operation process can be more stable,with less amount of PCIA,better analgesic effect,less adverse reactions,higher patient satisfaction.