右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响

Effect of dexmedetomidine on perioperative immunologic function in treatment of hiatal hernia combined with gastroesophageal reflux disease undergoing laparoscopic operation

目的探讨右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响。方法选取2014年3月至2016年3月,新疆维吾尔自治区人民医院收治并择期行全麻下腹腔镜手术治疗的食管裂孔疝合并胃食管反流病患者180例为研究对象,采用随机数字表法将上述研究对象分为观察组和对照组,各90例。观察组在麻醉诱导前30 min给予负荷剂量的右美托咪定(0.5μg/kg),手术开始后以维持剂量0.3μg/(kg·h)的速率泵人至手术结束;而对照组患者给予等负荷量和维持剂量的生理盐水。分别在不同时间点,即麻醉前(T1)、患者手术结束时(T2)、患者手术结束后30 min(T3)及患者手术结束后24 h(T4)使用流式细胞仪检测T淋巴细胞亚群和NK细胞水平并记录不良反应发生情况。结果 2组患者在T1时点免疫功能指标如血清CD3+、CD4+、CD8+、CD4+/CD8+和NK细胞水平比较,差异无统计学意义(P>0.05);与T1时点比较,2组患者在T2、T3和T4时点时CD3+、CD4+、CD4+/CD8+水平均显著降低;与对照组比较,观察组患者T2、T3和T4时CD3+、CD4+、CD4+/CD8+和NK水平明显升高(P<0.05)。与对照组比较,观察组心动过速、高血压发生情况有所降低(P<0.05),而心动过缓、低血压及苏醒延迟发生情况有所升高(P<0.05);寒颤、呼吸抑制的发生情况,2组比较,差异无统计学意义。结论右美托咪定辅助麻醉可显著改善行腹腔镜下治疗食管裂孔疝合并胃食管反流病患者围术期机体免疫功能,值得临床推广。

Objective To investigate the effect of dexmedetomidine on perioperative immune function in patients with hiatal hernia combined with gastroesophageal reflux disease by laparoscopic operation. Methods A total of 180 patients with hiatal hernia combined with gastroesophageal reflux disease undergoing operation by laparoscopy in our hospital from March 2014 to March 2016 were enrolled in the study. These patients were divided into observation group（90 cases） and control group（90 cases） by random digital table. A loading dose of dexmedetomidine with 0. 5 ｜jig/kg was givenat 30 min before induction of anesthesia,and after operation was started,dexmedetomidine was infused at 0. 3 ｜jig/（ kg ？ h） until the end of operation in observation group, and the equal loading dose and rateof normal saline was given in control group. The T lymohocyte subpopulations and NK cell levels in plasma were measured by flow cytometry before anesthesia（ T1） ,and after operation（ T2） ,30 minutes after operation（ T3 ） and 24 hours after operation（ T4）. The adverse reactions during operation were recorded. Results There were no significant differences in the levels of CD3 ＋ 、 CD4 ＋ 、 CD8 ＋ 、 CD4 ＋/CD8 ＋ and NK cells between two groups at T1 （ Z3 〉 0. 05 ） ; Compared with T1,the levels of CD3 ＋ 、 CD4 ＋ 、 CD8 ＋ 、 CD4 ＋/CD8 ＋ were significantly decreased in both groups at T2,T3 and T4;Compared with control group,the levels of CD3 ＋ ,CD4 ＋ ,CD4 ＋/CD8 ＋ and NK cells in peripheral blood were significant higher at T2, T3 and T4 （ P 〈 0. 05 ）. Compared with control group, the incidence of tachycardia and hypertension was decreased and bradycardia,hypotension and wake up delay increased（ P 〈0. 05） ;The incidence of chills and respiratory depression was compared in both groups, the difference was no statistically significant. Conclusion Dexmedetomidine assisting anesthesia cansignificantly improve perioperative immune function in patients undergoing operation by laparoscopy for hiatal hernia combined with gastroesophageal reflux disease,which is worthy of clinical promotion.