右美托咪定对全麻下老年患者腹腔镜结直肠癌手术的应激水平和术后细胞因子影响

Effects of dexmedetomidine on stress level and postoperative cytokines of the elderly patients with general anesthesia during laparoscopic colorectal cancer surgery

目的：探讨右美托咪定对全麻下老年患者腹腔镜结直肠癌手术术中的应激水平和术后细胞因子的影响。方法：选择60例65~80岁,ASA分级Ⅰ~Ⅱ级的拟行腹腔镜结直肠癌手术的患者,随机分为右美托咪定组和盐水组,每组30例：右美托咪定组在麻醉诱导前静脉泵注右美托咪定0.4μg/kg,10 min泵注完,麻醉维持时联合使用右美托咪定0.4μg·kg-1·h-1,而盐水组使用等量生理盐水。记录两组患者入室（T0）,泵注负荷剂量的右美托咪定后（T1）,气管插管后即刻（T2）,气腹时（T3）,气管拔管后即刻（T4）的平均动脉压（MAP）、心率（HR）和皮质醇（Cor）;T0,T4,术后24 h（T5）,术后48 h（T6）的白介素-6（IL-6）及白介素-10（IL-10）。结果：T1-4时点右美托咪定组患者的MAP及HR显著低于盐水组（P〈0.05）;T2-4时点右美托咪定组患者的Cor显著低于盐水组（P〈0.05）;T4-6时点右美托咪定组患者的IL-6显著低于盐水组（P〈0.05）;T4-6时点右美托咪定组患者的IL-10显著高于盐水组（P〈0.05）。结论：老年患者行全麻下腹腔镜结直肠癌手术辅用右美托咪定,有利于减少Cor的释放,减轻应激反应,有利于减轻促炎因子IL-6的释放,增加术后抗炎因子IL-10的释放,维持术后细胞因子的平衡。

AIM： To explore the effects of dexmedetomidine on stress levels and postoperative cytokines of the elderly patients with general anesthesia during laparoscopic colorectal cancer surgery. METHODS ： Sixty patients of ASA class Ⅰ -Ⅱ , age 65-80, undergoing laparoscopic colorectal cancer surgery, were randomly divided into two groups： dexmedetomidine group, and saline group. Patients of dexmedetomidine group were infused with dexmedetomidine （0.4μg/kg） within 10 minutes before anesthesia induction and another 0.4μg·kg·h^-1 dexmedetomidine during the maintenance of anesthesia. Patients of saline group were infused with the same amount of saline. Rates of MAP, HR and Cor were recorded before the use of dexmedetomidine （ T0）, after infusion of loading dose of dexmedetomidine （ T1）, immediately after intubation （ T2 ）, the moment of pneumoperitoneum （ T3 ）, immediately after extubation （ T4 ）. Interleukin-6 （IL-6） and In- terleukin-10 （IL-10） were measured at T0, T4, 24 h after operation （T5 ）, and 48 h after operation （T6）. RESULTS：At T1-4, MAP and HR in dexme- detomidine group were significantly lower than that in saline group （P 〈 0.05）. At T2-4, the cortisol of dexmedetomidine group was significantly lower than that in saline group （ P 〈 0.05 ）. At T4-6, IL-6 of dexmedetomidine group was significantly lower than saline group （ P 〈 0.05 ）. At T4-6, IL-10 of dexme-detomidine group was significantly higher than saline group （ P 〈 0.05 ）. CONCLUSION ： Dexmedeto- midine can help the elderly patients undergoing laparoscopie eolorectal cancer surgery with general anesthesia to reduce the eortisol release, relieve the stress reaction, decrease the IL-6 release, increase the IL-10 release and keep the balance of the cyto-kines after operation.