右美托咪定辅助用对结直肠癌腹腔镜手术患者应激、抗炎及镇痛效果的影响

Effects of auxiliary use of dexmedetomidine on stress,anti-inflammatory and analgesic effects in patients undergoing laparoscopic surgery of colorectal cancer

目的研究右美托咪定辅助用对结直肠癌腹腔镜手术患者应激、抗炎及镇痛效果的影响。方法选择2014年5月至2015年5月我院80例结直肠癌腹腔镜手术患者作为研究对象,随机分为两组,每组40例。观察组常规诱导麻醉后,给予右美托咪定持续泵入,对照组给予常规静吸复合麻醉。观察两组患者麻醉诱导时(T_1)、建立气腹时(T_2)、建立气腹后30 min(T_3)及手术结束时(T_4)应激反应、抗炎及镇痛效果。结果观察组在术中T_1、T_2、T_3及T_4时心率(HR)、平均动脉压(MAP)、血糖及皮质醇等应激反应指标比较,差异无统计学意义(P>0.05)。对照组在术中T_2、T_3及T_4时HR、MAP、血糖及皮质醇各指标显著高于T_1和观察组各时间点水平,差异均有统计学意义(P<0.05)。观察组术中T_1、T_2、T_3及T_4时白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞计数(WBC)各炎症指标比较,差异无统计学意义(P>0.05)。对照组术中T_2、T_3及T_4时IL-6、TNF-α、CRP及WBC显著高于T_1及观察组各时间点,差异均有统计学意义(P<0.05)。两组术中T_1、T_2、T_3及T_4时视觉疼痛评分(VAS)比较,差异无统计学意义(P>0.05)。结论右美托咪定辅助用于结直肠癌患者腹腔镜手术麻醉,能协助减轻患者应激反应,获得良好的抗炎镇痛效果,临床应用价值较高。

Objective To study the effects of auxiliary use of dexmedetomidine on stress, anti-inflammatory and analgesic effects in patients undergoing laparoscopic surgery of colorectal cancer. Methods 80 cases of patients with colorectal cancer who underwent laparoscopic surgery in our hospital between May 2014 and May 2015 were selected as the study objects and randomized into two groups, 40 cases in each. The observation group was treated with continous intravenous pumping of dexmedetomidine after general anesthesi while the control group was given routine intravenous inhalation combined anesthesia. The stress responses, anti-inflammatory and analgesic effects in the two groups at anesthesia induction （T1）, the establishment of pneumoperitoneum （T1）, 30 min after the establishment of pneumoperitoneum （T3） and at the end of surgery （T4） were observed. Results The differences of heart rate （HR）, mean arterial pressure （MAP）, blood glucose, cortisol and other stress indexes in the observa- tion group at intraoperative T1, T2, T3 and T4 were not statistically significant （P 〉 0.05）. The indexes mentioned above in the control group at intraoperative T2, T3 and T4 were significantly higher than those at T1 and those in the observation group at different time points （P 〈 0.05）. The differences of interleukin IL - 6 （IL-6）, tumor necrosis factor alpha （TNF-α）, C-reactive protein （CRP）, white blood cell count （WBC） and other inflamma- tion indexes in the observation group at T1, T2, T3 and T4 were not statistically significant （P 〉 0.05）. IL-6, TNF-α, CRP and WBC in the control group at T2, T3 and T4 were significantly higher than those at T1 and those in the observation group at different time points （P 〈 0.05）. There were no significant differences in visual analogue scale （VAS） pain scores between the two groups T~, T：, T3 and T4 （P 〉 0.05）. Conclusion The auxiliary use of dexmedetomidine in anesthesia of laparoscopic surgery for patients with colorectal cancer can markedly improve the stress responses and obtain good anti-inflammatory and analgesic effects. The clinical application value is high.