右美托咪定对腹腔肿瘤根治术围术期循环功能及炎性反应的影响

Effect of Dexmedetomidine on Circulation and Inflammatory Responses in Abdominal Tumor Radical Prostatectomy

目的研究腹腔肿瘤根治术围术期使用右美托咪定对循环功能和炎性反应的影响。方法选择医院2015年1月至8月全身麻醉下行腹腔肿瘤根治术患者60例,随机分为观察组和对照组,各30例。观察组患者麻醉诱导前给予小剂量右美托咪定(0.5μg/kg),10 min泵完,对照组患者给予同剂量的0.9%氯化钠注射液,10 min泵完。监测并记录麻醉诱导前30 min(T_0)、麻醉诱导开始后10 min(T_1)、气管插管前(T_2)、插管后即刻(T_3)的心率(HR)、收缩压(SBP)和舒张压(DBP),术前、术中、术后分别抽取外周静脉血3 mL,采用酶联免疫吸附试验(ELISA)法测定肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)水平。同时观察两组患者不良反应发生情况。结果围术期两组患者的SBP和DBP均有较大波动,但观察组波动幅度小于对照组(P<0.05)。两组患者T_1和T_2时的心率较T_0时显著下降(P<0.05),T_2较T_1进一步下降(P<0.05),T_3回升,观察组T_1和T_2时心率明显低于对照组(P<0.05)。气管插管后1 h(t_1)和术后6 h(t_2)时,两组TNF-α,IL-10,IL-6水平均较麻醉诱导前30 min(t_0)时明显升高(P<0.05),且t_2较t_1时进一步升高(P<0.05)。t_1和t_2时,观察组患者血清TNF-α,IL-10,IL-6水平均低于对照组(P<0.05)。两组患者均未见明显不良反应。结论腹腔肿瘤根治术麻醉诱导前给予右美托咪定能有效减轻患者的血压波动,减轻炎性反应,但可引起心率降低,故输注速度不能过快,以提高围术期安全性。

Objective To study the effect of dexmedetomidine on the circulation and inflammatory responses of patients with abdominal tumor radical prostatectomy. Methods 60 cases of patients with abdominal tumor radical prostatectomy from Jannuary 2015 to August 2015 were randomly divided into observation group and control group,30 cases in each group. Before anesthesia induction,the observation group was given a small dose of dexmedetomidine 0. 5 μg / kg,pumped in 10 min; the control group was given the same dose of 0. 9% NaCl injection,pumped in 10 min. The heart rate（ HR）,systolic blood pressure（ SBP） and diastolic blood pressure（ DBP） were monitored and recorded. During preoperative,intraoperative and postoperative,peripheral venous blood 3 mL was extracted respectively,using the ELISA method for determination of TNF- α,IL- 6,IL- 10 levels. At the same time,the occurrence rate of adverse reactions in both groups were observed. Results The perioperative SBP and DBP between the two groups had greater volatility,but volatility in the observation group was smaller than the control group（ P〈0. 05）. The heart rate at T1 and T2 of the two groups decreased significantly（ P〈0. 05）,when compared with T0,T1 and T2 represented a further decline（ P〈0. 05）,T3 showed a rebound,and the heart rates of the observation group at T1 and T2 were significantly lower than the control group（ P〈0. 05）. At T1 and T2,the TNF- α,IL- 10,IL- 6 levels of the two groups increased significantly when compared with T0（ P〈0. 05）,T1 and T2 showed further increase when compared with T0（ P〈0. 05）. TNF- α,IL- 10,IL- 6 levels at T1 and T2 in the observation group were lower than the control group（ P〈0. 05）. The two groups showed no obvious adverse reactions. Conclusion Peritoneal tumor resection prior to induction of anesthesia administered dexmedetomidine can effectively reduce the fluctuation of blood pressure patients and reduce inflammation,but can cause decreased heart rate,so the infusion rate cannot be too fast in order to improve perioperative safety.