右美托咪定对妇科腹腔镜手术围术期病人TNF-α和IL-6的影响

EFFECT OF DEXMEDETOMIDINE ON TNF-αAND IL-6IN PERIOPERATIVE PATIENTS UNDERGOING GYNECOLOGICAL LAPAROSCOPIC SURGERY

目的探讨右美托咪定对妇科腹腔镜手术围术期炎性细胞因子肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）的影响。方法选取ASAⅠ～Ⅱ级、择期行妇科腹腔镜手术病人40例,随机分为右美托咪定组（D组）和对照组（C组）各20例。D组病人麻醉诱导前10min静脉泵入右美托咪定1μg/kg,继以0.3μg/（kg·h）维持;C组病人按照D组病人的给药模式静脉泵入等量的生理盐水。于麻醉诱导前（T1）、气腹后30 min（T2）、术毕即刻（T3）、术后24h（T4）采血检测TNF-α、IL-6浓度,并于特定时间点记录两组平均动脉压和心率。结果与T1时相比,两组T2～T4时血清TNF-α和IL-6浓度显著升高（F=2.124～13.481,P〈0.05）。与C组相比,D组病人T2～T4时血清TNF-α和IL-6浓度较低（t=3.417～6.380,P〈0.05）,且血流动力学更稳定。结论一定剂量的右美托咪定可降低妇科腹腔镜手术围术期病人血清中TNF-α和IL-6的浓度,维持血流动力学稳定,减轻应激反应。

Objective To investigate the effects of dexmedetomidine on tumor necrosis factor-α（TNF-α）and interleukin-6（IL-6）in patients undergoing gynecological laparoscopic surgery（GLS）. Methods Forty patients with ASA gradesⅠ-Ⅱ,scheduled for GLS under general anesthesia were enrolled and equally randomized to dexmedetomidine（DMT）group and control group.The patients in DMT group were given DMT 1μg/kg through venous pump,10 min before anesthesia induction,and continued to maintain with a dose of 0.3μg/（kg·h）,and those in the control group were given equivalence of normal saline in the same administration route as done in DMT group.Blood TNF-αand IL-6were measured before anesthesia induction（T1）,30 min after pneumoperitoneum（T2）,upon completion of surgery（T3）,and 24 hours after operation（T4）,the heart rate（HR）and mean arterial pressure（MAP）in given period of time were recorded. Results Compared with T1,serum TNF-αand IL-6at T2-T4 in both groups increased（F=2.124-13.481,P〈0.05）.Compared with the control group,serum levels of TNF-αand IL-6at T2-T4 in DMT group were lower（t=3.417-6.380,P〈0.05）,and hemodynamics was more stable. Conclusion A certain dose of dexmedetomidine can decrease perioperative serum concentration of TNF-αand IL-6in patients undergoing gynecological laparoscopic surgery,maintain stable haemodynamics and relieve stress reaction.