右美托咪定对老年胃癌手术患者免疫功能、炎性因子及血流动力学的影响

The effect of dexmedetomidine on the immune function,serum inflammatory factors and hemodynamics in elderly patients with gastric cancer

目的:探讨右美托咪定对老年胃癌手术患者免疫功能、血清炎性因子及血流动力学的影响。方法:以我院2015年9月至2017年3月收治的老年胃癌根除术患者84例为研究对象,随机分为对照组和观察组各42例。其中对照组麻醉诱导前给予氯化钠注射液静脉输注,观察组则行右美托咪定静脉输注。比较两组血流动力学指标HR、MAP水平、血清炎症因子CRP、IL-2、IL-10水平以及T淋巴细胞亚群水平的变化。结果:与麻醉诱导前相比,两组术后6h的HR水平均有显著升高(P<0.05),术后6h对照组MAP水平显著升高(P<0.05)而观察组MAP水平变化不明显(P>0.05)。与对照组同期相比,观察组术后6h的HR水平、MAP水平均显著低于对照组(P<0.05)。与麻醉诱导前相比:两组患者术后各时间点CRP水平均显著升高(P<0.05);两组术后24h的IL-2水平显著降低(P<0.05),而在术后72h均有所回升且与麻醉诱导前相比均显著升高(P<0.05);两组术后24h的IL-10均显著升高(P<0.05),而在术后72h均有所回落且与麻醉诱导前相比均显著降低(P<0.05)。与对照组同期相比,观察组在术后6、24、72h的CRP、IL-10水平显著低于对照组,IL-2水平显著高于对照组,差异均有统计学意义(P<0.05)。与麻醉诱导前相比,对照组在术后6、24、72h的CD3^+、CD4^+、CD4^+/CD8^+水平均显著降低(P<0.05);观察组在术后24h上述指标均显著降低(P<0.05),而在术后72h均有回升且与麻醉诱导前相比变化不明显(P>0.05)。同时间组间比较,术后6、24、72h观察组的CD3^+、CD4^+、CD4^+/CD8^+水平均显著高于对照组(P<0.05)。结论:右美托咪定用于老年胃癌手术辅助麻醉可减轻患者因手术创伤产生的应激反应,改善免疫水平,减轻炎症反应,且对患者围术期的血流动力学有显著稳定作用,值得临床推广。

Objective:To investigate the effect of dexmedetomidine on the immune function,serum inflammatory factors and hemodynamics in elderly patients with gastric cancer.Method:84 elderly patients with gastric cancer treated in our hospital from September 2015 to March 2017 were randomly divided into the control group and the observation group,each with 42 cases.The control group received intravenous infusion of Sodium Chloride Injection before anesthesia induction,and the observation group received dexmedetomidine intravenous infusion.The levels of hemodynamic indexes HR and MAP levels,serum inflammatory factors levels of CRP,IL-2,IL-10 levels and T lymphocyte subsets levels were compared between the two groups.Results:Compared with induction of anesthesia before,the HR level of two groups were both significantly increased at 6 hafter operation(P<0.05),the MAP level of control group was significantly increased(P<0.05)at 6 hafter operation while was not changed significantly in the observation group(P>0.05).According comparison between groups at 6 hafter operation,the levels of HR,MAP in observation group were significantly lower than those of the control group(P<0.05).Compared with induction of anesthesia before,the CRP level was significantly increased at each postoperative time point in two groups(P<0.05);the IL-2 level at 24 hafter operation of two groups were decreased significantly(P<0.05),while both increased back and significantly higher than that before induction of anesthesia(P<0.05);the IL-10 level at 24 hafter operation of two groups were increased significantly(P<0.05),while both decreased back and significantly lower than that before induction of anesthesia(P<0.05).Compared with the control group at the same time point,the CRP,IL-10 level of observation group were significantly lower than those of the control group and the IL-2 level of observation group was significantly higher than that of the control group(P<0.05).Compared with induction of anesthesia before,the levels of CD3^+,CD4^+,CD4^+/CD8^+ of control group were significantly decreased at 6 h,24 h,72 hafter operation(P<0.05)and significantly decreased at24 hafter operation in observation group.72 hafter operation,the levels of CD3^+,CD4^+,CD4^+/CD8^+ of observation group increased back and were not changed significantly compared with induction of anesthesia before(P>0.05).Compared with the control group at the same time point,6 h,24 h,72 hafter operation,the levels of CD3^+,CD4^+,CD4^+/CD8^+ of observation group were significantly higher than that of the control group(P<0.05).Conclusion:Dexmedetomidine for elderly patients with gastric cancer assisted anesthesia can reduce the stress caused by surgical trauma,improve the immune level,reduce the inflammatory response,and stabilize hemodynamics of patients in the perioperative period significantly.It is worthy of clinical promotion.