右美托咪啶联合丙泊酚麻醉对肝癌切除术患者围手术期血清细胞因子和术后苏醒质量的影响

Effects of dexmedetomidine combined with propofol anesthesia on perioperative stress response and postoperative recovery quality in patients undergoing hepatectomy

目的探讨应用右美托咪啶联合丙泊酚麻醉对肝癌切除术患者围手术期应激反应、T细胞亚群和术后苏醒质量的影响。方法 2015年1月～2017年3月在我院接受肝癌切除术的原发性肝癌患者68例,随机分为观察组34例和对照组34例。在麻醉诱导前15 min,给予对照组生理盐水静脉滴注,在观察组,给予右美托咪啶0.5μg·kg^(-1)静脉滴注,在10 min内输注完成,再给予0.4μg·kg^(-1)·h^(-1)静脉滴注维持至术毕。其他麻醉方法两组相同。麻醉诱导前30 min(T0)、术后即刻(T1)、术后24 h(T2)、术后48 h(T3)时检测T淋巴细胞亚群百分比和血清干扰素(IFN)-γ、白细胞介素(IL)-2、IL-10、皮质醇、促肾上腺皮质激素和醛固酮水平。在插管即刻(Ta)和拔管即刻(Tb)时测量收缩压(SBP)、舒张压(DBP)和中心静脉压(CVP)。结果在Ta、T1和Tb时,观察组收缩压、舒张压和中心静脉压均显著低于对照组(P<0.05);在T1、T2和T3时,观察组外周血CD3^+、CD4^+和NK细胞百分比及CD4^+/CD8^+比值均显著高于对照组,差异有统计学意义(P<0.05);在T1、T2和T3时,观察组血清IFN-γ和IL-2水平均显著低于对照组,而IL-10水平均显著高于对照组,差异有统计学意义(P<0.05);在T2和T3时,观察组血清皮质醇、促肾上腺皮质激素和醛固酮水平均显著低于对照组,差异有统计学意义(P<0.05);术后观察组呛咳评分和躁动评分均显著低于对照组,差异有统计学意义(P<0.05)。结论应用右美托咪啶联合丙泊酚麻醉可以改善肝癌切除术患者围手术期应激反应和免疫功能,并且能够提高术后苏醒质量。

Objective To investigate the effects of dexmedetomidine combined with propofol anesthesia on perioperative stress response,lymphocyte subsets and postoperative recovery quality in patients undergoing hepatectomy.Methods 68 patients with primary liver cancer were admitted to our hospital between January 2015 and March 2017,and the patients were divided into observation and control group with 34 patients in each group.Fifteen minutes before anesthesia,the dexmedetomidine at dose of 0.5μg·kg^-1 or saline were intravenously given in the observation or the control patients,and the anesthesia were the same in both groups.The percentages of T lymphocyte subsets and NK cells,and the serum interferon(IFN)-γ,interleukin(IL)-2,IL^-10,cortisol,adrenocorticotropic hormone,and aldosterone levels were detected at 30 min before induction of anesthesia(T0),immediate postoperative(T1),postoperative 24 h(T2),and postoperative 48 h(T3)and systolic blood pressure(SBP),diastolic blood pressure(DBP)and central venous pressure(CVP)were measured immediately after intubation(Ta)and extubation(Tb).The cough and dysphoria after surgery were scored.Results The SBP,DBP and CVP in the observation group at Ta,T1 and Tb were significantly lower than those in the control group(P<0.05);the percentages of CD3^+,CD4^+and NK cells as well as ratio of CD4^+/CD8^+cells in the observation group were mugh higher than in the control group at T1,T2 and T3(P<0.05);serum IFN-γand IL-2 levles in the observation group were much lower,while serum IL^-10 levels were higher than in the control group at T1,T2 and T3(P<0.05);serum levels of cortisol,adrenocorticotropic hormone and aldosterone in the observation group were significantly lower than in the control group at T2 and T3(P<0.05);the cough and dysphoria scores after hepatectomy in the observation group were much lower than in the control group(P<0.05).Conclusion The anesthesia by dexmedetomidine combined with propofol can inhibit the stress response and improve the quality of postoperative recovery in patients with liver cancer undergoing hepatectomy.