右美托咪定辅助全身麻醉在胃癌根治术中的应用价值

Value of dexmedetomidine assisted general anesthesia in radical gastrectomy

目的探讨胃癌根治术中右美托咪定辅助全身麻醉对患者围术期血流动力学、免疫和炎性因子的影响。方法选择武警陕西省总队医院2017年2月至2019年6月收治的98例拟行胃癌根治术患者为研究对象,根据随机数表法分为对照组和观察组,每组49例。对照组采用全身麻醉,观察组采用右美托咪定辅助全身麻醉。记录并比较两组患者围术期的心率(HR)、平均动脉压(MAP)、呼吸(RR)、血氧饱和度(SpO2);检测并比较两组患者围术期的T淋巴细胞(CD3^+、CD4^+、CD8^+)水平;检测并比较两组患者围术期的白介素-6(IL-6)、白介素-10(IL-10)、白介素-1β(IL-1β);采用Ramsay镇静评分、视觉模拟量表(VAS)评价两组患者的镇静和镇痛效果。结果观察组患者麻醉诱导前(T1)、切皮时(T2)、手术结束时(T3)、苏醒时(T4)的HR、RR、SpO2与对照组比较差异均无统计学意义(P>0.05),但观察组患者的MAP明显高于对照组,差异有统计学意义(P<0.05);观察组患者T1~T4时的CD3^+、CD4^+、CD8^+水平明显高于对照组,血清IL-6、IL-10、IL-1β水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者苏醒30 min^3 h时的视觉模拟评分(VAS)明显低于对照组,差异均有统计学意义(P<0.05)。结论右美托咪定辅助全身麻醉有助于稳定胃癌根治手术患者围术期血流动力学稳定,降低血清炎性细胞因子水平,保护免疫功能,并具有显著的镇静镇痛效果。

Objective To investigate the effect of dexmedetomidine assisted general anesthesia on perioperative hemodynamics,immunity,and inflammatory factors in patients with gastric cancer.Methods Ninety-eight patients with gastric cancer undergoing radical gastrectomy in Shaanxi Provincial Armed Police Corps Hospital from February 2017 to June 2019 were selected as the research objects,and they were randomly divided into control group and observation group,with 49 patients in each group.The control group was given general anesthesia,and the observation group was given dexmedetomidine assisted general anesthesia.The perioperative heart rate(HR),mean arterial pressure(MAP),respiration(RR),and blood oxygen saturation(SpO2)of the two groups were recorded and compared;the levels of T lymphocytes(CD3^+,CD4^+,CD8^+)in the two groups were detected and compared;the perioperative levels of interleukin-6(IL-6),interleukin-10(IL-10),interleukin-1β(IL-1β)were detected and compared between the two groups;the sedative and analgesic effects were evaluated by Ramsay sedation score and Visual Analogue Scale(VAS).Results The HR,RR,and SpO2 before anesthesia induction(T1),at skin incision(T2),at the end of operation(T3),and at recovery(T4)showed no statistically significant difference between the two groups(P>0.05),but the MAP of the observation group was significantly higher than that of the control group(P<0.05).The levels of CD3^+,CD4^+,CD8^+at T1,T2,T3,T4 in the observation group were significantly higher than those in the control group,and the serum IL-6,IL-10,and IL-1βin the observation group were significantly lower than those in the control group(P<0.05).The VAS scores 30 min to 3 h after recovery in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Dexmedetomidine assisted general anesthesia is helpful to stabilize the perioperative hemodynamics,reduce the level of serum inflammatory cytokines,protect the immune function,and has significant sedative and analgesic effects.