盐酸右美托咪定对食管癌根治术患者围术期血糖、β-内啡肽、TNF-α及IL-6表达的影响

Effects of dexmedetomidine on blood glucose,β-endorphin,tumor necrosis factor-α and interleukin-6 in patients undergoing radical esophagectomy

目的观察全麻期间持续应用盐酸右美托咪定对食管癌根治术患者围术期血糖、β-内啡肽(β-EP)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)表达水平的影响。方法 40例择期行食管癌根治术的患者,所有患者均采用全凭静脉麻醉,随机分为盐酸右美托咪定组和对照组(n=20)。两组分别于麻醉诱导前(T0)、拔管(T1)即刻、术后ld(T2)和术后2d(T3)晨抽取静脉血,测定血糖、血浆β-EP、血清TNF-α和IL-6水平。结果与T0点相比,对照组在T1时点MAP和HR显著升高(P<0.05),T1～T3时点血糖、血浆β-EP浓度显著升高(P<0.05),T1～T2时点血清TNF-α和IL-6的浓度明显上升(P<0.05);盐酸右美托咪定组在各时点均无明显变化,两组各时间点差异有统计学意义(P<0.05)。结论全麻期间持续应用盐酸右美托咪定可有效降低食管癌根治术患者围术期血糖、血浆β-EP、血清TNF-α和IL-6水平,抑制围术期应激反应。

Objective To investigate the effects of dexmedetomidine on blood glucose,β-endorphin（β-EP）,tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6） levels in patients undergoing radical esophagectomy,and to discuss the possible mechanism.Methods Forty patients with esophageal carcinoma undergoing radical esophagectomy were randomly assigned to 2 groups：dexmedetomidine group and control group （n=20 in each）.Blood samples were taken immediately before induction of anesthesia（T0）,immediately after tracheal extubation（T1）,day 1 and day 2 after operation（T2,T3） for determining the levels of blood glucose,plasma β-EP and serum TNF-α and IL-6.Results Compared with those at T0,MAP and HR at T1were significantly elevated （P〈0.05） in the control group,the blood glucose and plasma β-EP at T1-T3were significantly increased （P〈0.05）,and the serum TNF-α and IL-6 at T1 and T2 were significantly elevated（P〈0.05）.The blood glucose,plasma β-EP,serum TNF-α and IL-6 in dexmedetomidine group had no significant changes at all time points （P〉0.05）,and the above parameters were significantly different between the two groups at corresponding time pionts （P〈0.05）.Conclusion Continued application of dexmedetomidine can effectively decrease the levels of blood glucose,plasma β-EP,serum TNF-α and IL-6 in patients undergoing radical esophagectomy,inhibiting the peri-operative stress response.