右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子及认知功能的影响

Effect of Dexmedetomidine on Inflammatory Factors and Cognitive Function in Patients Undergoing Laparoscopic Uterine Malignant Tumor Surgery

目的:探讨右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子以及认知功能的影响,为右美托咪定在腹腔镜下子宫恶性肿瘤手术的临床应用提供参考。方法:选择武汉科技大学附属普仁医院2015年7月至2017年6月收治的100例行腹腔镜下子宫恶性肿瘤手术患者作为研究对象,根据不同麻醉方式分为观察组和对照组两组,各50例,其中观察组患者在给予麻醉诱导前30 min,负荷剂量1.0μg/kg的右美托咪定静脉输注10 min,之后给予患者0.5μg/kg的右美托咪定持续性静脉输注至手术结束前30 min为止,对照组患者按照上述给药方法静脉输注同等容量的生理盐水。然后分别于麻醉诱导前(T0)、手术结束时(T1)、手术结束后4 h(T2)以及手术结束后1天(T3)取患者的外周静脉血,测定比较两组患者各相应时间点的血清C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)等炎症因子水平,外周血皮质醇(cor)、肾上腺素(E)、去甲肾上腺素(NE)等应激水平,MMSE评分、TMT完成时间等认知功能;并分析两组患者术后的不良反应发生情况。结果:两组患者T0时间的血清IL-6、TNF-α、CRP、cor、E、NE水平以及TMT、MMSE认知功能评分差异不具有统计学意义(P>0.05),具有可比性;而观察组患者T1、T2、T3各相应时间点的血清IL-6、TNF-α、CRP、cor、E以及NE水平明显低于对照组(P<0.05);观察组患者T2、T3各相应时间点的MMSE评分明显高于对照组,TMT评分值明显低于对照组(P<0.05);且术后观察组患者的不良反应发生率明显低于对照组(P<0.05)。结论:右美托咪定可以明显降低腹腔镜下子宫恶性肿瘤手术患者血清应激反应以及炎症因子水平,改善术后认知功能,减少术后不良反应的发生,效果显著,值得临床推广使用。

Objective:To investigate the effect of dexmedetomidine on inflammatory factors and cognitive function in patients undergoing laparoscopic uterine malignant tumor surgery and provide a reference for the clinical application of dexmedetomidine in laparoscopic uterine malignant tumor surgery.Methods:from July 2015 to June 2017,100 patients undergoing laparoscopic uterine malignant tumor surgery in Pu Ren Hospital affiliated to Wuhan University of Science and Technology were selected as the research subjects.They were divided into observation group and control group according to different anesthesia methods,two cases in each group,50 cases in each group.the patients in the observation group were given intravenous drip of dexmedetomidine(10μg/kg)for 30 minutes before the induction of anesthesia and the dose of 1.0μg/kg.The patients in the observation group were divided into observation group and control group randomly.Patients were then given 0.5μg/kg dexmedetomidine sustained intravenous infusion until the end of surgery 30 min so far,the control group patients according to the above method of intravenous infusion of the same volume of saline.The patients’peripheral venous blood was taken before the induction of anesthesia(T0),at the end of the operation(T1),4 h after the operation(T2)and one day after the operation(T3),the levels of serum C-reactive protein(CRP),tumor necrosis factor(TNF-α),interleukin-6(IL-6)and other inflammatory cytokines,(E),norepinephrine(NE)and other stress levels,MMSE score,TMT completion time and other cognitive functions;and analysis of two groups of patients after the occurrence of adverse reactions.Results:There was no significant difference in serum IL-6,TNF-α,CRP,cor,E and NE levels and TMT and MMSE cognitive function scores at T0 between the two groups(P>0.05).The levels of IL-6,TNF-α,CRP,cor,E and NE in T1,T2 and T3 in observation group were significantly lower than those in control group(P<0.05).MMSE scores of observation group at T2 and T3 were significantly higher than those of control group,and TMT score was significantly lower than that of control group(P<0.05).The incidence of adverse reactions in the postoperative observation group was significantly lower than that in the control group(P<0.05),with statistical significance.Conclusion:Dexmedetomidine can significantly reduce serum stress response and inflammatory cytokines in patients undergoing laparoscopic surgery for malignant uterine cancer,improve postoperative cognitive function and reduce the occurrence of postoperative adverse reactions.The results are significant and worthy of clinical application.