右美托咪定对妇科腹腔镜手术患者围术期炎症因子及应激反应的影响

Influence of dexmedetomidine on perioperative period inflammatory factor and stress reaction in patients with gynecological laparoscopic operation

目的探讨右美托咪定对妇科腹腔镜手术患者围术期炎症因子及应激反应的影响。方法选择180例妇科腹腔镜手术患者,随机分为两组,每组90例。对照组患者静脉输注0.5μg/kg舒芬太尼、1.8 mg/kg丙泊酚、0.6 mg/kg罗库溴铵进行麻醉诱导,术中吸入七氟醚行麻醉维持,并间断静脉推注顺苯磺阿曲库铵维持肌松。观察组麻醉诱导前静脉泵注0.5μg/kg右美托咪定负荷剂量,之后以0.5μg/（kg·h）输注至术毕前10 min,其余麻醉方法与对照组相同。观察麻醉诱导前10 min（T0）、气管插管后即刻（T1）、建立气腹时（T2）、气腹建立30 min后（T3）、手术结束时（T4）5个时间点的血流动动力学变化情况,使用酶联免疫吸附法检测炎症指标,以及血管紧张素Ⅱ、皮质醇及醛固酮等应激反应指标。结果与T0时间点比较,观察组T1～T3心率（HR）均明显下降（P〈0.05）,对照组T1～T3 HR均明显上升（P〈0.05）,对照组发生心动过速1例,观察组未发生;与T_0时间点比较,观察组T1～T4有创平均动脉压（MAP）未发生明显变化,对照组T1～T4 MAP明显上升,组间比较差异明显（P〈0.05）;与T_0时间点比较,两组的IL-6、IL-10及TFN-α均明显上升,而对照组上升程度明显高于观察组（P〈0.05）;与T0时间点比较,两组的血管紧张素Ⅱ、皮质醇及醛固酮均明显上升,且对照组上升程度明显高于观察组（P〈0.05）。结论麻醉诱导前静脉泵注0.5μg/kg右美托咪定负荷剂量,之后以0.5μg/（kg·h）输注至术毕前10 min,可以维持妇科腹腔镜手术围术期的血流动力学稳定,抑制围术期炎症反应及应激反应。

Objective To investigate the influence of dexmedetomidine on perioperative period inflammatory factor and stress reaction in patients with gynecological laparoscopic operation. Methods Totally 180 cases of gynecologic laparoscopic surgery were randomly divided into two groups, 90 cases in each group. The patients in control group were iv given 0.5 g/kg and 1.8 mg/kg propof01, sufentanil 0.6 mg/kg rocuronium anesthesia. With inhalation of sevoflurane to maintain anesthesia, and intermittent iv injection of Cisatraeurium Besylate for Injection to maintain＇ muscle relaxation, The patients in observation group were given 0.5 1g/kg dexrnedetomidine before anesthesia induction, and 0.5 μg/（kg.h） infusion to 10 rain before the end of surgery, the others anesthesia were same with the control group. Observation The blood flow dynamics were observed at five time points such as 10 rain before anesthesia （To）, after tracheal intubation immediately （T1）, establishment of pneumoperitoneum （T2）, after pneumoperitoneum established 30 min.（T3）, and at the end of surgery （T4）. Using enzyme-linked immunosorbent assay, the inflammatory markers, as well as angiotensin II, cortisol, aldosterone, and other stress response indicators were detected. Results The HR of observation group at T1 to T3 was lower than that at To （P 〈 0.05）, while the HR of the control group was obviously higher （P 〈 0.05）. The tachycardia of the control group was 1 case, the observed had none, without significant difference. Compared with To, the MAP of the observation group at T1 to T4 had no significant difference, while that of the control group was obvious higher, with significant difference （P 〈 0.05）. Compared with before anesthesia induction for 10 min, the IL-6, IL-10, and TFN-α of two groups were obviously higher （P 〈 0.05）, while the rising degree of the control group were higher than the observation group （P 〈 0.05）. Compared with before anesthesia induction for 10 min, the angiotensin Ⅱ, cortisol, and aldosterone of two groups were obviously higher （P 〈 0.05）, the rising degree of the control group were higher than the observation group （P 〈 0：05）. Conclusion Before anesthesia induction given 0.5 lg/kg dexmedetomidine, and 0.5 ig/（kg.h） infusion to 10 min before the end of surgery, which could maintain the gynecologic laparoscopic surgery perioperative hemodynamic stability and control the perioperative inflammatory response and stress response.