Effect Of Dexmedetomidine Preconditioning On Stress Response In Patients With Liver Cancer Radiofrequency Ablation

BackgroundWith the development of minimally invasive interventional procedures and radiofrequency instruments,more and more patients with liver cancer have been treated with radiofrequency ablation.Compared with traditional open surgery,radiofrequency ablation is a minimally invasive procedure with less invasiveness and high safety.However,the nervousness and anxiety of patients are not reduced,which may lead to different degrees of stress response and interfere with the process of operation.Generally,local anesthesia or single-use analgesic drugs can not achieve satisfactory sedative effect.As a highly selectiveα₂ adrenergic receptor agonist,dexmedetomidine has good effect on sedative,analgesic,anti-anxiety.Besides,the patients are easy to wake up,emotionally stable,almost no adverse reaction such as respiratory depression,nausea or vomiting.ObjectiveDexmedetomidine pretreatment is used in patients with radiofrequency ablation of liver cancer for the study,it provided theoretical guidance for optimizing clinical medication by observing its sedative effect and its effect on stress response.Methods82 patients undergoing radiofrequency ablation of liver cancer were chosen,they were divided into two groups by the random number method:dexmedetomidine（group D）and midazolam（group M）.However,in the actual experiment,4 patients were transferred.Finally,38 patients in group D and 40 patients in group M were included.2%lidocaine was given before operation by local infiltration anesthesia.Group M was given intravenous injection of 0.05 mg/kg midazolam before surgery,1.0μg/kg fentanyl,followed by intravenous infusion of midazolam at a rate of 0.05 mg·kg^-1·h^-1;group D was given intravenous injection dexmedetomidine 0.5μg/kg（slow injection within 10 min）before surgery,fentanyl 1.0μg/kg,and then dexmedetomidine was infused intravenously at a rate of 0.5μg·kg^-1·h^-1.The doses of midazolam and dexmedetomidine were 0.1 mg/kg and 1.0μg/kg,respectively,physiological saline was added to made 20 m L.The levels of SBP,DBP,HR,RR,SPO2,E,NE,GLU before entering operating room（T0）,10 minutes after surgery（T1）and the end of surgery（T2）in the two groups were recorded,and Fenta Nie usage were recorded,The concentration of noradrenaline（NE）,epinephrine（E）and Glu in the serum of the two groups at different time points were determined by enzyme-linked immunosorbent assayhypotension,hypertension,respiratory depression,intraoperative physical activity were recorded,the patient’s intraoperative fit and the surgeon’s satisfaction with the sedative effect were assessed.Result1.Compared with T0,SBP and DBP were significantly increased in group M and group D at T1（P<0.05）,while SBP and DBP were still at a high level in group M at T2（P<0.05）.Compared with T0,HR was significantly increased in group M at T1（P<0.05）,significantly decreased in group D（P<0.05）,and significantly decreased in group D at t1-t2（P<0.05）.Compared with T0,RR in group M and group D was significantly lower at T1（P<0.05）,and RR in group D was significantly higher than that in group M（P<0.05）.RR in group M and group D were basically restored to the pre-entry level at T2.Compared with T0,SPO₂ in group M and group D was significantly decreased at T1（P<0.05）,while at T2,SPO₂ in group M was still at a low level（P<0.05）.However,SPO₂ in group D basically recovered to the pre-entry level,significantly higher than that in group M（P<0.05）.2.Compared with T0,E and NE were significantly increased in group M and group D from T1 to T2（P<0.05）,but E and NE were significantly lower in group D from T1 to T2than in group M（P<0.05）.Compared with T0,GLU was significantly increased in group M from T1 to T2（P<0.05）,while GLU was not significantly changed in group D,which was significantly lower than that in group M（P<0.05）.3.The amount of fentanyl in the group D was less than that in the group M（P<0.05）.4.The incidence of nausea and vomiting,hypotension,hypertension,respiratory depression and intraoperative physical activity in the D group was lower than that in the group M（P<0.05）.ConclusionPretreatment with dexmedetomidine can reduce the stress response of patients undergoing RFCA.