| BackgroundDue to the characteristics of the surgical site,such as larger operation area,higher risk of infection,the complications are easy to be produced.When facing surgery,patients show anxiety and fear.Besides,insomnia and postoperative painand surgical trauma to the body,all these factors can cause strong stress reaction.Excessive stress can lead to a lot of damage to the body,such as cardiovascular function,to respiratory function,and to various organs.Worse still,it can endanger the lives of patients.Dexmedetomidine hydrochloride(DEX)as a highly selective alpha 2A-R agonist,has been widely applied in clinical practice due to its unique characterrstics,such as sedation,an anlgesia,anti-anxiety and nhibition of sympathetic excitation.ObjectiveTo investigate the effect of dexmedetomidine hydrochloride pre-injection on the perioperative stress response in patients undergoing thoracotomy.MethodAccording to the approval of the hospital ethics committee,80 patients in the Department of thoracic surgery of Xinxiang First People's Hospital were selected to open thoracic surgery,the ASA grade was I to II,the age was 30 to 70 years and the weight was 40 to 85 kg.All patients were randomly divided into two groups according to single and double days: S group(dexmedetomidine group,n=42)and D group(control group,n=38).According to the exclusion criteria,12 cases were excluded from group S,8 cases were excluded from group D,and 30 cases were finally included in the two groups.There were no serious systemic diseases such as hypertension,coronary heart disease,immunity and endocrinology,no obvious liver and kidney dysfunction and the history of taking antipsychotic drugs or sedative hypnotic drugs.Patients in groupS(dexmedetomidine group)received intravenous dexmedetomidine infusion at a 0.5ug/kg loading dose after infusion into the operation room,and the pump time was 10 minutes.After that,0.4ug/kg/h continued infusion of dexmedetomidine to 30 minutes before the end of operation.The patients in group D(control group)were given the same dosage of saline.Two groups of patients were prepared for the same preoperative preparation,fasting 12 hours,and no drinking4 hours.After entering the operation room,venous passages were established,continuous monitoring of heart rate(HR),blood pressure(BP),pulse oxygen saturation(SPO2),bispectral index(BIS)and electrocardiogram(ECG)were monitored continuously.All patients were treated with general intravenous anesthesia,intravenous administration of midazolam,sufentanil citrate,propofol and CIS atracurium in order of anesthesia induction,when the BIS value reached 40 to 60,double lumen tracheal intubation was performed after maintenance of 5seconds.Continuous pump into remifen-tanil and propofol,according to the BIS monitoring values,adjust the dose to maintain the appropriate depth of anesthesia.Use of the intravenousself controlled analgesia pump at the end of the operation.At 10 minutes before induction of anesthesia(T0),the end of intubation(T1),30 minutes after operation(T2),at the end of operation(T3),after extubation(T4),8 hours after operation(T5),12 hours after operation(T6),24 hours after operation(T7),were extracted from peripheral venous blood in patients with 2ml injection in vitro,enzyme linked immunosorbent assay(ELISA)was used to detect the values of NE,ACTH and COR at each time period.At the same time,the changes of BIS values and perioperative hemodynamic changes in the two groups were recorded,and the postoperative pain visual analogue scale(VAS)was evaluated.Analysis of the results: Statistical analysis was performed using the SPSS 21.0 version of the statistical software.The statistical data were expressed as mean±standard deviation(x±s).The data between groups were compared using independent sample t test.P<0.05 was considered statistically significant.Intragroup data comparison uses variance analysis of repeated measurement data.Result1.The basic situation of the two groups of patients: there was no significant difference between the groups of age,weight,anesthesia and operation time(P>0.05).2.The average arterial pressure(MAP)and heart rate(HR)were compared between the two groups.Group comparison: group S(dexmedetomidine group)Tl-T7 was significantly lower than group D(control group),and the difference in T1-T6 time was statistically significant(P<0.05).Intra group comparison: group S(dexmedetomidine group): at T2 and T3 times lower than T0,there were statistically significant differences(P<0.05).Group D(control group): compared with the time of T0,the time of T1-T7 was higher than that of T0,of which T1 and T4 were significantly higher,and the difference was statistically significant(P<0.05).3.The comparison of serum NE,ACTH and COR in the two groups of patients at each time period: the change trend is the same,compared with the T0 time,the NE,ACTH and COR of the two groups increased gradually,and reached the highest value at T4 time,then decreased gradually.the difference between groups was statistically significant(P<0.05).Group comparison: at T1toT7 time,the value of group S(dexmedetomidine group)was lower than that of group D(control group),and there was significant difference between thetwo groups at thetime ofT2 to T7(P<0.05).4.The difference of BIS value between the two groups was statistically significant(P<0.05)during the period of anaesthesia(T3,T4).5.Thecomparisonof VAS in the two groups:the VAS value of group S(dexmedetomidine group)was lower than that of group D(control group)at Complete waking time after extubation of tracheal catheter to24 hours after the operation,and there was statistical difference in the time of tracheal catheter drawing out completely and 8 hours after operation(P<0.05).ConclusionDexmedetomidine pre-injection for anesthesia in patients with thoracotomy can make patients get more stable hemodynamics during perioperative period.Inhibiting the secretion of norepinephrine,adrenocorticotropin and cortisol can reduce the stress response in perioperative patients,therefore patients will get better postoperative analgesic effects andfacilitate postoperative recovery. |
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