艾司洛尔对腹腔镜胃肠癌根治术患者免疫应激及血流动力学的影响

Effects of esmolol on immune stress and hemodynamics in patients with gastrointestinal cancer undergoing laparoscopic radical gastrectomy

目的探讨老年腹腔镜胃肠癌根治术患者术中持续泵注艾司洛尔对患者血流动力学和免疫应激指标的影响。方法选取泸州市中医医院2015年8月至2017年3月收治的112例拟实施老年腹腔镜胃肠癌根治术患者,采用随机数表法分为观察组和对照组各56例,观察组于插管前3 min静注艾司洛尔0.3 mg/kg,术中持续泵注艾司洛尔50μg/(kg·min)至气管拔管,对照组给予等量生理盐水。监测并对比两组患者麻醉诱导前(T0)、气管插管后(T1)、手术结束时(T2)、拔管即刻(T3)、拔管后30 min(T4)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR);对比两组患者麻醉诱导前、术毕、术后24 h的血清白细胞介素-4(IL-4)、IL-6、γ-干扰素(INF-γ)、肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)的水平。结果在T1、T2时刻观察组患者的MAP分别为(94.8±7.3)mm Hg(1 mm Hg=0.133 k Pa)、(94.8±7.3)mm Hg,均明显高于对照组的(83.2±7.7)mm Hg、(84.7±6.9)mm Hg,而在T3时刻为(91.7±5.8)mm Hg,明显低于对照组的(96.0±7.2)mm Hg,差异均有统计学意义(P<0.05);T1、T2、T3时刻观察组患者的HR、RR值均明显低于对照组,差异均有统计学意义(P<0.05);在术毕、术后24 h,观察组患者的IL-4、IL-6、E、NE、DA测定值均明显低于对照组,而INF-γ测定值均明显高于对照组,差异均有统计学意义(P<0.05)。结论老年腹腔镜胃肠癌根治术患者术中持续泵注艾司洛尔有利于维持术中血流稳定性、降低应激反应程度及免疫损伤。

Objective To investigate the effect of continuous infusion of esmolol on hemodynamics and immune stress in elderly patients with gastrointestinal cancer undergoing laparoscopic radical gastrectomy. Methods A total of 112 patients who underwent laparoscopic radical gastrectomy were enrolled in Luzhou Hospital of Traditional Chinese Medicine from August 2015 to March 2017. They were divided into observation group and control group accroding to random number table, with 56 patients in each group. The observation group received intravenous injection of esmolol 0.3 mg/kg 3 minutes before intubation and continuous infusion of esmolol 50 μg/（kg· min） during operation to tracheal extubation, while the control group were given the same amount of saline. The mean arterial pressure（MAP）, heart rate（HR） and respiratory rate（RR） of the two groups were monitored and compared before anesthesia induction（T0）, after tracheal intubation（T1）, at the end of surgery（T2）, immediately after extubation（T3） and 30 minutes after extubation（T4）. The levels of serum interleukin-4（IL-4）, interleukin-6（IL-6）, interferon-γ（INF-γ）, epinephrine（E）, norepinephrine（NE）, dopamine（DA） were compared before anesthesia induction, at the end of surgery, and 24 h after the operation. Results The MAP of the observation group was（94.8 ± 7.3） mm Hg and（94.8 ± 7.3） mm Hg at T1 and T2, which were significantly higher than（83.2±7.7） mm Hg and（84.7±6.9） mm Hg of the control group（P〈0.05）, respectively. The MAP of the observation group was（91.7±5.8） mm Hg at T3, which was significantly lower than（96.0±7.2） mm Hg of the control group（P〈0.05）. The HR and RR of patients in the observation group at T1, T2, and T3 were significantly lower than those in the control group, with statistically significant differences（P〈0.05）. At the end of surgery and 24 hours after operation, the levels of IL-4, IL-6, E, NE, and DA in the observation group were significantly lower than those in the control group. However, the INF-γ value in the observation group was significantly higher than that in the control group, with statistically significant difference（P〈0.05）. Conclusion Continuous infusion of esmolol during laparoscopic radical resection of gastrointestinal cancer in elderly patients is conducive to maintaining intraoperative blood flow stability, reduce the degree of stress response and immune injury.