右美托咪定对腹腔镜子宫全切患者炎性因子的影响

Effect of Dexmedetomidine on Inflammatory Cytokines in Patients Undergoing Laparoscopic Surgery

目的了解右美托咪定对腹腔镜子宫全切患者外周血炎性因子的影响。方法择期行腹腔镜下子宫全切术患者50例,年龄40-62岁,ASA分级Ⅰ-Ⅱ级,体重40-72 kg,采用随机数字表法,将其分为对照组和观察组,每组各25例。观察组麻醉诱导前30 min静脉输注右美托咪定负荷剂量1.0μg·kg^-1,输注时间10 min,随后持续静脉泵注0.5μg·kg^-1·h^-1至术毕前30 min;对照组采用同样方法静脉输注等容量生理盐水。分别于T0（麻醉诱导前）、T1（气腹开始后30 min）、T2（气腹结束时）和T3（术后4 h）,抽取外周静脉血,检测血清CRP、TNF-α、IL-1β浓度。结果与T0时相比,对照组患者T1-T3时CRP、TNF-α、IL-1β浓度均明显升高,观察组患者仅T2-T3时上述指标明显升高（P〈0.05或0.01）。与对照组比较,观察组患者T2-T3时间点血清CRP、TNF-α、IL-1β浓度均明显降低（P〈0.05）。结论麻醉诱导前及术中给予右美托咪定静脉输注可抑制妇科腹腔镜手术中炎性因子的释放。

Objective To investigate the effect of dexmedetomidine on inflammatory cytokines in patients undergoing laparoscopic surgery. Methods Fifty ASA Ⅰ-Ⅱ patients aged 40-62 yr weighing 40-72 kg scheduled for laparoscopic total hysterectomy were randomly divided into 2 groups（ n = 25） ： control group and dexmedetomidine group. D Dexmedetomidine 1. 0 μg·kg^-1was infused iv over 10 min before anesthesia induction,and then was infused at a rate of 0. 5 μg·kg^-1·h^-1（ group D） until 30 min berore the end of operation. Group C received the equal volume of normal saline. Blood samples were collected T0（ before anesthesia induction）,T1（ 30 min after pneumoperitoneum）,T2（ at the time of closing pneumoperitoneum） and T3（ 4 hours after operation） for determination of serum CRP,TNF-α and IL-1βconcentrations by nephelometry and ELISA. Results Compared with T0,serum CRP,TNF-α and IL-1βconcentrations were significantly increased at T1- T3 in group C and at T2- T3 in group D（ P〈0. 05 or0. 01）. Compared with group C,serum CRP,TNF-α and IL-1β concentrations were significantly decreased at T2- T3 in group D（ P〈0. 05 o）. Conclusion Dexmedetomidine 1. 0 μg·kg^-1given before induction and then infused at a rate of 0. 5 μg·kg-1·h^-1during operation can decrease the concentrations of serum Inflammatory cytokines such as CRP,TNF-α and IL-1β in patients undergoing laparoscopic surgery.