右美托咪定对老年胃癌患者围术期IL-1β、IL-6、TNF-α及CRP的影响及作用机制探讨

The Influence of Dexmedetomidine on IL-1β,IL-6,TNF-α,CRP and Mechanism in Elderly Patients with Gastric Cancer

目的探讨右美托咪定对老年胃癌患者围术期IL-1β、IL-6、TNF-α及CRP的影响及作用机制。方法选择2010年1月至2015年12月我院收治的82例胃癌根治术的老年患者,随机分为观察组及对照组,观察组麻醉诱导前10min内静脉泵入1μg/kg右美托咪定,以0.2μg/kg·h速度维持至术毕,对照组泵入等量的生理盐水。观察两组患者在T0、T1、T2、T3点的血流动力学指标(HR、MAP)及炎症因子(IL-1β、IL-6、TNF-α及CRP)。结果对照组与观察组患者在T1、T2时间点时,HR水平与T0相比均显著上升,对照组在T1、T2时间点MAP较T0显著升高,而观察组仅在T2时间点与T0有显著差异,且对照组的HR、MAP上升均较观察组明显,P均<0.05,两组在T1、T2、T3时的IL-1β、IL-6、TNF-α及CRP较T0均明显上升,而观察组的上升幅度均较对照组小,P均<0.05。结论右美托咪定可以稳定老年胃癌围术期的血流动力学,降低围术期的IL-1β、IL-6、TNF-α及CRP炎症因子水平,可能通过下调核因子-κB表达的抗炎途径、激活胆碱能抗炎通路或咪唑啉结构发挥抗炎作用。

Objective To investigate the influence of Dexmedetomidine on perioperative inflammatory factors and mechanism in elderly patients with gastric cancer.Methods A total of 82 elder patients with gastric cancer from January 2010 to December 2015 in our hospital were chosen and randomly divided into the observation group and control group.The observation group was given intravenous pump 1μg/kg dexmedetomidine before anesthesia induction for 10 min,the 0.2μg/kg ·h maintain to end of surgery.The control group were given same amount of saline solution.The hemodynamic index（HR,MAP） and inflammatory factors（IL-1β、IL-6、TNF-α and CRP） of two groups at T0、T1、T2、T3 were observed.Results The HR of two groups at T1、T2 was significant different.The MAP of the control group at T2 was higher than T0,while the observation group was significant different.The HR,MAP of the control group was obviously higher than the control group,P〈0.05.The IL-1β、IL-6、TNF-α and CRP at T1、T2、T3 of two group were higher than T0,while the ascensional range of the observation group were less than the control group,P〈0.05.Conclusion Dexmedetomidine could stabilize the perioperative hemodynamics of elderly patients with gastric cancer,decrease the perioperative IL-1β、IL-6、TNF-α and CRP level,which could down-regulate the nuclear factor-κB expression and activate the cholinergic anti-inflammatory pathway.