右美托咪定对腹腔镜下结直肠癌根治术患者应激及炎性因子的影响

Effects of Dexmedetomidine on Stress Reactions and Inflammatory Factors in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

目的探讨右美托咪定应用于腹腔镜下结直肠癌根治术时对患者应激及炎性因子的影响。方法选择行腹腔镜下结直肠癌根治术的40例患者采用单盲法随机分为对照组和观察组各20例,观察组于麻醉诱导前10min内泵入右美托咪定1μg·kg-1,并以0.4μg·kg-1·h-1持续泵注至手术结束前30min,对照组给予同等剂量生理盐水。分别于入室前(T0)、建立气腹时(T1)、气腹建立后2h(T2)、拔管时(T3)4个时间点进行血流动力学指标比较,采用酶联免疫吸附(ELISA)法测定血清中白细胞介素8(IL-8)、肿瘤坏死因子-α(TNF-α)及血清皮质醇(COR)水平,并进行组间比较。结果与T0时间点比较,观察组T1~T3时间点心率(heart rate,HR)均明显下降(P<0.05),对照组T1~T3时间点HR均明显上升(P<0.05);与T0时间点相比,观察组T1~T3时间点平均动脉压(mean arterial pressure,MAP)未发生明显变化,对照组T1~T3时间点MAP明显高于观察组(P<0.05);与T0时间点相比,2组IL-8、TNF-α、COR均明显上升,且对照组上升程度明显高于观察组(P<0.05)。结论麻醉诱导前10min内泵入右美托咪定1μg·kg-1,并以0.4μg·kg-1·h-1持续泵注至手术结束前30min可维持腹腔镜下结直肠癌根治术患者术中血流动力学稳定,抑制围术期炎性反应和应激反应。

Objective To discuss the effect of dexmedetomidine on the stress reaction and inflammatory factors in patients undergoing laparoscopic radical resection of colorectal cancer.Methods 40 patients receiving laparoscopic radical resection of colorectal cancer were randomly divided into observation group and control group through single blind methods with 20 patients in each group.Observation group were pumped dexmetomidine 1μg·kg-1 10 minutes before anesthesia induction,followed by the continuous pump injection with 0.4μg·kg-1·h-1 until30 minutes before the end of the operation.Control group were given the same volume of normal saline.Hemodynamic indexes were compared at four time points respectively：before the house（T0）,pneumoperitoneum establishment（T1）,2 hafter pneumoperitoneum establishment（T2）and extubation（T3）.ELISA method was used to determine the level of interleukin 8（IL-8）,tumor necrosis factor alpha（TNF-α）and cortisol（COR）in serum,and make comparison between groups.Results Compared with T0,the heart rate in the observation group at T1~T3 decreased significantly（P〈0.05）,and the heart rate in the control group at T1~T3 increased significantly（P〈0.05）.Compared with T0,the mean arterial pressure in the observation group at T1~T3 was not significantly changed,and the mean arterial pressure in the control group at T1~T3 was significantly higher than that in the observation group（P〈0.05）.Compared with T0,the level of IL-8,TNF-αand COR in two groups both increased significantly,and the rise degree of the control group was significantly higher than that of the observation group（P〈0.05）.Conclusion Dexmedetomidine was pumped 1 ug·kg-1 at 10 minutes before anesthesia induction,followed by the continuous pumped 0.4μg·kg-1·h-1 until 30 minutes before the end of the operation,which can maintain the hemodynamic stability of patients undergoing laparoscopic radical resection of colorectal cancer and inhibit the inflammatory reaction and stress reaction of perioperative.