| Research BackgroundOvarian cancer is the most dangerous type of cancer in gynecological tumors,and is known as the "king of women’s cancer".The 5-year survival rate of patients is very low because the patients are mostly in the late stage when they are discovered and treated.At present,the treatment of ovarian cancer at home and abroad is mostly cytoreductive surgery(CRS)+ hyperthermic intraperitoneal chemotherapy(HIPEC).CRS uses surgery to remove visible lesions,while HIPEC technology uses the drug action of chemotherapeutics and the thermal effect of hyperperfusion to eliminate residual tumor cells in the pelvic and abdominal cavity.A large number of studies have shown that CRS+HIPEC can enhance the diagnosis and treatment effect and effectively extend the life of patients.However,CRS takes a long time,the surgical method is more complicated,and involves more organs.And the temperature during HIPEC is higher during the operation,coupled with the application of a large number of anesthetics,etc.These characteristics determine that patients have certain pathophysiological changes during the perioperative period.Studies have found that during HIPEC,the body temperature measured through the esophagus,bladder or tympanic membrane can rise to 40.5°C(average 37.5°C)due to the continuous infusion of the high-temperature solution.High temperature not only puts the body in a state of high metabolism,but also affects blood perfusion in the brain.Cerebral oxygen saturation(Regional cerebral oxygen saturation,rSCO2)monitoring is based on near-infrared spectroscopy(NIRS)to determine the oxygenation of the mixed blood of arteries and veins in local areas of the brain to assess the metabolic status of brain tissue.Indirectly reflects the situation of cerebral perfusion.At present,it is mostly used for the guidance of intraoperative cerebral perfusion and the prediction of postoperative outcome,and it has been widely used in a variety of operations.High temperature can also lead to increased metabolism of the body and an imbalance in tissue oxygen supply and oxygen consumption,leading to hypoxia in some tissues.The concentration of blood glucose and blood lactic acid in the arterial blood gas analysis can be used to judge the metabolism of the tissue.Dexmedetomidine(Dex)as an α2 adrenergic receptor agonist,because of its special receptor site and short elimination half-life,it is widely used in clinical anesthesia[1][2].Studies have shown that Dex can reduce cerebral blood flow and cerebral metabolic rate through sedation [3].In addition,basic experimental studies have found that Dex also has many effects such as anti-inflammatory,anti-oxidative stress,anti-excitatory toxicity,inhibiting cell apoptosis,and lowering blood lactic acid [4] [5].However,it is not clear whether Dex also has a protective effect in postoperative intraperitoneal hyperthermic perfusion chemotherapy.Therefore,this article intends to study the effect of Dexmedetomidine injection on cerebral oxygen saturation and blood gas analysis in patients with ovarian cancer immediately after hyperthermic perfusion chemotherapy.Provide a certain reference for clinical medication.PurposeTo study the effect of dexmedetomidine on the physiological indexes of patients with ovarian cancer during immediate hyperthermic perfusion.MethodPatients who underwent elective abdominal ovarian cancer cell cytoreduction surgery at the Second Affiliated Hospital of Zhengzhou University from September 1,2019 to December 31,2020 were selected as the research subjects.A total of 40 patients who met the research criteria were included.Between 35~65 years old;Body Mass In Dex(BMI)is between 18～28kg/m2;American Society of Anesthesiologists(ASA)classification: 13 cases of grade Ⅰ,27 cases of grade Ⅱ.Using random number table method,they were divided into two groups(20 cases in each group),namely Dexmedetomidine group(group D)and control group(group C).After the patient enters the operating room,he is given routine vital sign monitoring,BIS monitoring and rSCO2 monitoring.Open venous access.Radial artery puncture and catheterization under local anesthesia to monitor invasive arterial blood pressure.After everything is ready,conventional anesthesia induction is performed,tracheal intubation is assisted by the Division endoscope,and volume-controlled mechanical ventilation is performed after the operation is successful.Continuous intravenous infusion of propofol medium/long-chain fat emulsion injection,remifentanil hydrochloride for injection,inhalation of sevoflurane to maintain anesthesia.Give intravenously atracurium cissylate and sufentanil citrate according to the needs of the operation.During the operation,adjust the amount of anesthetics to keep BIS 40 ~ 60 and vital signs basically stable.At the end of the operation,four indwelling pelvic-abdominal drainage tubes were led out through puncture on the left and right sides of the abdominal wall.After the operation,group D was given a slow intravenous pump injection of 1.0μg/kg of Dexmedetomidine for 15 minutes before the start of the thermal perfusion,and then continued infusion at a rate of 0.5 μg/(kg·h)until the end of the thermal perfusion 20min;in group C,0.9% saline was pumped at the same dose and rate to 20 minutes before the end of thermal perfusion.Preparation before intraperitoneal hyperthermic perfusion chemotherapy:add chemotherapeutic drugs to 3000 ml of0.9% sodium chloride solution and preheat to 43°C.After the preparation is completed,connect the inlet and outlet water pipes and treat them at a constant temperature of43°C for 60 minutes,and the perfusion is smooth.The subjects were after entering the operating room(T0),after the end of the operation(T1),10 minutes of thermal perfusion(T2),30 minutes of thermal perfusion(T3),60 minutes of thermal perfusion(T4),and 30 minutes of thermal perfusion stop(T5).Measure the patient’s cerebral oxygen saturation(rSCO2),temperature(T),mean arterial pressure(MAP),and heart rate(HR);At the same time,perform arterial blood gas analysis at T0,T1,T3,and T5,and extract the blood lactate(Lac)and blood glucose(Glu)values in the results;measure the tumor necrosis factor(TNF-a)and interleukins of the patient before and after the operation-6(IL-6)concentration.Result1.There was no significant difference in age,BMI,ASA classification,and operation time between the two groups of patients(P>0.05).2.Results of rSCO2: There was no statistically significant difference in rSCO2 between group C and group D(P>0.05),and the difference within the group was statistically significant(P<0.05);Results of T: Compared with group C and D,the difference between groups was not statistically significant(P>0.05),and the difference within the group was statistically significant(P<0.05);Results of HR: at T2,T3,T4,and T5,the HR of patients in group D was lower than that in group C,and the difference was statistically significant(P<0.05);Results of MAP: at T2,T3,T4,T5,the MAP of patients in group D was lower than that in group C,the difference was statistically significant(P<0.05).3.Glu results: at T3 and T5 time points,the blood glucose concentration of patients in group D was lower than that in group C,and the difference was statistically significant(P<0.05);Lac results: at T3 and T5 time points,the blood lactic acid concentration of patients in group D was lower than that in group C,and the difference was statistically significant(P<0.05).4.After operation,the TNF-a and IL-6 of group D were lower than those of group C,and the difference was statistically significant(P<0.05).ConclusionDuring the immediate postoperative intraperitoneal hyperthermic perfusion therapy,dexmedetomidine has no effect on cerebral oxygen saturation and temperature,but it can maintain the relative stability of hemodynamics,reduce stress and reduce inflammation. |
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