右美托咪定联合依托咪酯对直肠癌根治术患者应激反应、细胞免疫功能的影响

Effect of Dexmedetomidine Combined with Etomidate on Stress Response and Cellular Immune Function in Patients Undergoing Radical Resection of Rectal Cancer

目的探讨右美托咪定联合依托咪酯对直肠癌根治术患者应激反应、细胞免疫功能的影响.方法选取直肠癌根治术患者96例,以简单随机化法分为研究组(n=32)、对照A组(n=32)、对照B组(n=32).3组均采取静吸复合全麻,对照A组术中持续泵注依托咪酯0.2 mg/(kg·h),对照B组术中持续泵注右美托咪定0.3μg/(kg·h),研究组术中持续泵注依托咪酯0.2 mg/(kg·h)和右美托咪定0.3μg/(kg·h).对比3组麻醉诱导前(T0)、手术切皮时(T1)、切除标本时(T2)、术毕时(T3)血流动力学指标(收缩压(SBP)、舒张压(DBP)、心率(HR))及T0、T3、术后12 h(T4)、术后24 h(T5)应激反应(皮质醇(Cor)、去甲肾上腺素(NE)、血糖(Glu))、细胞免疫功能(CD4^+/CD8^+、CD4^+、CD8^+),统计3组麻醉恢复情况及不良反应发生率.结果研究组T1、T2、T3时SBP、DBP、HR水平波动小于对照A组、对照B组(P<0.05);3组T3、T4、T5时Cor、NE、Glu水平较T0时增高,但研究组低于对照A组、对照B组(P<0.05);研究组T3、T4、T5时血清CD4^+/CD8^+、CD4^+、CD8^+水平较T0时降低,但研究组高于对照A组、对照B组(P<0.05);3组气管拔管时间、麻醉苏醒时间、呼吸恢复时间及不良反应发生率比较差异无统计学意义(P>0.05).结论右美托咪定联合依托咪酯麻醉应用于直肠癌根治术能进一步减轻术中应激刺激,降低对细胞免疫功能影响,且不良反应发生风险低.

Objective To investigate the effects of dexmedetomidine combined undergoing etomidate on the stress response and cellular immune function in patients undergoing radical rectal cancer surgery.Method A total of 96 patients with radical rectal cancer were divided into study group(n=32),control group A(n=32)and control group B(n=32).The three groups were given intravenous inhalation combined with general anesthesia,control group A was continuously pumped with etomidate 0.2 mg/(kg·h)during operation,and control group B was pumped with dexmedetomidine 0.3μg/(kg·h)in the study group,etomidate 0.2 mg/(kg·h)and dexm-edetomidine 0.3μg/(kg·h)were continuously pumped during the operation.The hemodynamics(SBP,DBP,H)before anesthesia induction(T 0),at the time of skin incision(T 1),at the time of specimen resection(T 2)and at the time of operation(T 3)and the stress response(cortisol(COR),norepinephrine(NE),blood glucose(Glu))and cellular immune function(CD4+/CD8+,CD4+,CD8+)of T 0,T 3,twelve hours after operation(T 4),twenty-four after operation(T 5)were compared among the three groups,statistics on the recovery of anesthesia and the incidence of adverse reactions in the three groups.Results The fluctuations of SBP,DBP and HR levels in study group T 1,T 2 and T 3 were less than those in control group A and control group B(P<0.05);The levels of Cor,NE,and Glu at T 3,T 4 and T 5 in the three groups were higher than those at T 0,but the study group was lower than those in the control A and B groups(P<0.05);Serum CD4^+/CD8^+,CD4^+,and CD8^+levels in study group T 3,T 4 and T 5 were lower than those in T 0,but the study group was higher than those in control group A and control group B(P<0.05);There was no significant difference in tracheal extubation time,anesthesia recovery time,respiratory recovery time and incidence of adverse reactions in the three groups(P>0.05).Conclusion Dexmedetomidine combined with etomidate anesthesia for radical rectal cancer surgery can further reduce the stress stimulus during surgery and reduce the effect on cellular immune function,it will not increase the risk of adverse reactions and affect postoperative recovery.