右美托咪定在肠道手术患者麻醉中的效果及对炎性反应影响

The Effect of Dexmedetomidine Anesthesia in Patients Undergoing Intestinal Surgery and Its Impact on Inflammatoryn Response

目的评价右美托咪定在肠道手术麻醉中的效果及其对炎性反应的影响。方法选取我院2017年2月—2018年1月择期行肠道手术68例作为研究对象,按照随机数字法分为观察组(n=31)和对照组(n=37)。所有患者均行基础麻醉,观察组麻醉诱导前10 min静脉输注负荷剂量右美托咪定1μg/kg,以0. 4μg/(kg·h)的速度输注至术毕;对照组予等容量0. 9%氯化钠注射液。观察给药前(T0)、泵入右美托咪定10 min后(T1)、手术开始即刻(T2)、手术开始后30 min(T3)和手术结束即刻(T4)时心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、脑电双频指数(bispectral index,BIS)、白细胞介素(interleukin,IL)-6、IL-8、IL-10、肿瘤坏死因子(tumor necrosis factor,TNF)-α、C-反应蛋白(C reactive protein,CRP)及CD11b水平变化,记录术后呼吸恢复时间、拔管时间和术后躁动发生情况。结果与本组T0比较,观察组T1时HR、T1～T4时BIS下降,对照组T2～T4时HR、MAP升高且BIS下降,两组T2～T4时IL-6、IL-8、IL-10、TNF-α、CRP和CD11b水平均升高,差异有统计学意义(P <0. 05);与对照组比较,观察组T1～T4时HR、T2～T4时MAP、IL-6、IL-8、TNF-α、CRP和CD11b及T1时BIS均降低,T2～T4时IL-10水平升高,差异有统计学意义(P <0. 05)。观察组术后呼吸恢复时间、拔管时间明显短于对照组,术后躁动发生率显著低于对照组,差异均有统计学意义(P <0. 05)。结论麻醉诱导前输注右美托咪定可以稳定肠道手术患者术中血流动力学,有利于术后苏醒,减少术后躁动,抑制机体炎性反应。

Objective To evaluate dexmedetomidine anesthesia in patients undergoing intestinal surgery and its impact on the inflammatory response.Methods From February2017to January2018,68patients undergoing elective intestinal surgery in our hospital were selected as the subjects.According to random number table method,they were randomly divided into observation group(n=31)and control group(n=37).All patients underwent basal anesthesia,and then observation group was intravenously infused with dexmedetomidine(1g/kg)10min before induction of anesthesia,followed by intravenous infusion at the rate of0.4g·kg^-1·h^-1until the completion of operation.The control group was given normal saline.Heart rate(HR),mean arterial pressure(MAP),bispectral index(BIS),interleukin(IL)-6,IL-8,IL-10,tumor necrosis factor(TNF)-α,C-reactive protein(CRP)and CD11b levels in the two groups were recorded before treatment(T0),10min after pump dexmedetomidine(T1),immediately after initiation of operation(T2),30min(T3)after the initiation of operation,and immediately after operation(T4).The respiratory recovery time after surgery,extubation time and incidence of postoperative agitation were compared between the two groups.Results Compared with T0,the levels of HR at T1and BIS at T1-T4in observation group were decreased,while HR and MAP were increased and BIS was decreased in the control group at T2-T4.The levels of IL-6,IL-8,IL-10,TNF-α,CRP and CD11b in the two groups were increased at T2-T4,and the difference was statistically significant(P<0.05).HR at T1-T4,MAP,IL-6,IL-8,TNF-α,CRP,and CD11b at T2-T4,and BIS at T1in observation group were decreased,whereas IL-10was increased at T2-T4,suggesting significant differences(P<0.05).Respiratory recovery time and extubation time of the observation group after surgery were significantly shorter than those of the control group,and the incidence of postoperative agitation was significantly lower than that of the control group(P<0.05).Conclusion Infusion of dexmedetomidine before anesthesia induction can stabilize intraoperative hemodynamics in patients undergoing intestinal surgery,which is beneficial to postoperative recovery,reduction of postoperative agitation and inhibition of inflammatory response.