| Objective:The goal of this study was to investigate dexmedetomidine co-administered with general anesthesia compared to epidural anesthesia combined with general anesthesia undergoing endoscopic gastrointestinal surgery,to observe the effects of postoperative gastrointestinal function recovery,and to provide reference for clinical selection of anesthesia.Methods:Choosing performed laparoscopic gastrointestinal surgery 90 patients,ASA 1 to 3 level,30 to 75 years old,body mass index 16～28kg/m~2,for the hospital from October 2016 to January 2019;no epidural anesthesia or contraindication of dexmedetomidine infusion.They were stratified block randomization into three groups:control group(general anesthesia group,group G),epidural anesthesia and general anesthesia group(group E),and dexmedetomidine and general anesthesia group(group D).According to the site of surgery,group E performs epidural catheterization at the corresponding segment,and gave the test dose of lidocaine.If the patient had no signs of subarachnoid space block and local anesthetic poisoning,0.2% ropivacaine 5ml epidural infusion and 0.2% ropivacaine 5ml/h continuous epidural infusion were given.Group D patients were given intravenous infusion of dexmedetomidine 0.5μg/kg for 10 minutes before induction of general anesthesia.Subsequently,a continuous intravenous infusion of 0.4μg/kg·h was administered to the vital abdomen.Before induction of general anesthesia,group E and group G was also given intravenous infusion of saline 0.75ml/kg·h for 10 minutes,subsequently,a continuous intravenous infusion 0.1ml/kg·h was administered to the vital abdomen.All patients in the three groups were induced and maintained with total intravenous anesthesia.The primary outcome measures were the first postoperative venting time(FFL),the first defecation time(FFE),and the time the patient was able to tolerate solid foods.The secondary outcome measures were preoperative,intraoperative,and postoperative.The mean arterial pressure,heart rate,the amount of anesthetic and vasoactive drugs,the time of postoperative resuscitation,and the complications associated with postoperative hospitalization were observed at different time points.Result:1.There was no statistical difference in the general information of patients.2.Three groups of patients after the postoperative reflection of gastrointestinal function recovery of the FFL,FFE,the time to tolerate solid food comparison.(1)Group C ompared with the group G,group E and group D patients FFL time(group E:74±25.5h vs 95±30.3h,~aP=0.003;group D:71±20.2h vs 95±30.3h,~bP=0.001)were significantly shortened(P<0.05).(2)FFE time for patients in group E and group D compared to the group G(group E:84±23.9h vs 107±26.8h,~aP=0.005;Group D:86±20.9h vs 107±26.8h,~bP=0.001)were significantly shortened(P<0.05).(3)The time of resistance to solid foods in group E and group D patients compared to group G(group E:97±28.7h vs 115±25.8h,~aP=0.022;group D:96±27.4 vs 115±25.8h,~bP=0.020) were significantly shortened,the difference was statistically significant(P<0.05).(4)The time of FFL,FFE and solid food was not significantly different in group E and group D patients(P>0.05).3.Infusion of dexmedetomidine can reduce the elevation of blood pressure during intubation and extubation,and reduce the occurrence of nausea and vomiting after operation(P<0.05);the dosage of opioids in group D and group E is lower than that in group G(P<0.05);extubation time in group E is significantly earlier than G group(P<0.001),D group(P=0.001),and the difference was statistically significant(P<0.05);D group and G group extubation time,the difference was not statistically significant(P>0.05).The general anesthesia group required more remedial analgesics within 12 hours after surgery than the other two groups.The difference was statistically significant(P<0.05).Conclusion:In laparoscopic general anesthesia of the gastrointestinal tract,intravenous infusion of dexmedetomidine does not differ in the promotion of postoperative gastrointestinal function recovery compared with epidural anesthesia,but better than general anesthesia. |
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