右美托咪定对腹腔镜直肠癌根治术患者炎性反应及改善术后肺功能的效果

Effect of Dexmedetomidine on Inflammatory Reaction and Improvement of Postoperative Pulmonary Function in Patients with Laparoscopic Radical Resection of Rectal Cancer

目的观察右美托咪定对腹腔镜直肠癌根治术患者炎性反应及改善术后肺功能的效果。方法选取2015年1月—2017年2月收治的腹腔镜直肠癌根治术92例,按治疗方法分为研究组和对照组,每组46例。对照组在常规麻醉基础上加用生理盐水,研究组在常规麻醉基础上静脉持续泵注盐酸右美托咪定。比较2组手术期间心率、平均动脉压(MAP)、脑电双频谱指数(BIS),检测2组手术期间血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平,并通过动脉血气分析对比2组术后肺功能变化情况。结果研究组T1~T4时点心率低于对照组(P<0.05);对照组T1~T4时点心率高于T0时点(P<0.05)。研究组T1~T4时点MAP低于对照组(P<0.05);对照组T1~T4时点MAP高于T0时点(P<0.05)。对照组T1~T4时点的IL-6、TNF-α及CRP水平均高于T0时点(P<0.05);研究组T1~T4的IL-6、TNF-α及CRP水平均低于对照组(P<0.05)。治疗后,对照组呼吸指数(RI)和肺泡-动脉分压差[P(A-a)O2]水平高于治疗前(P<0.05);研究组治疗后RI和P(A-a)O2水平低于对照组(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论右美托咪定可以有效抑制腹腔镜直肠癌根治术患者的炎性反应,平稳呼吸力学和动脉血气指标,对肺功能有改善作用,同时可以降低患者术后不良反应,安全性较高。

Objective To investigate effect of Dexmedetomidine on inflammatory reaction and improvement of postoperative puhnonary function in patients with laparoscopic radical resection of rectal cancer. Methods A total of 92 patients with laparoscopic radical resection of rectal cancer admitted during January 2015 and February 2017 were divided into study group and control group according to different treatment methods （n = 46 for each group）. Control group was added with physiological saline on the basis of routine anesthesia, while study group was given continuous intravenous infusion of Dexmedetomidine on the basis of routine anesthesia. Levels of heart rate （ HR）, mean arterial pressure （MAP） and bispectral index （BIS） during operation were observed, and levels of serum interleukin -6 （IL-6）, tumor necrosis factor-α （TNF-α） and C reactive protein （CRP） during operation were detected, and then changes of puhnonary function after operation were compared by arterial blood gas analysis in two groups. Results At T1-T4, HR values in the study group were significantly lower than those in control group （ P 〈 0.05 ）. In control group, HR values at T1 -T4 were significantly higher than that in TO （P 〈 0.05 ）. At T1-T4, MAP values in study group were significantly lower than those in control group （ P 〈 0.05 ）. In control group, MAP values at T1-T4 were significantly higher than that at TO （ P 〈 0.05 ）. At T1 -T4, IL-6, TNF -α and CRP levels were significantly higher than that at TO in control group （ P 〈 0.05 ） , while the levels in study group were significantly lower than those in control group （ P 〈 0.05 ）. After treatment, levels of respiratory index （RI） and alveolar-arterial oxygen partial pressure difference [ P （A-a） O2 ] were significantly higher than those before treatment in the control group （P 〈 0.05 ）. After treatment, RI and P （A-a） 02 levels in study group were significantly lower than those in control group （P 〈 0.05 ）. Incidence rate of adverse reactions in observation group was significantly lower than that in control group （ P 〈 0.05 ）. Conclusion Dexmedetomidine may effectively inhibit inflammatolT reaction in patients with laparoseopie radical resection of rectal cancer, stabilize indexes of breathing mechanics and arterial blood gas, improve pulmonary function and reduce incidence rate of adverse reaction with safety.