右美托咪定复合七氟烷对子宫肿瘤切除术患者围术期应激反应及T淋巴细胞亚群的影响

Effects of Dexmedetomidine Combined with Sevoflurane on Perioperative Stress Response and T Lymphocyte Subsets in Patients Undergoing Hysterectomy

目的探讨右美托咪定复合七氟烷对子宫肿瘤切除术患者围术期应激反应及T淋巴细胞亚群的影响。方法选择90例行腹腔镜下全子宫切除术^+盆腔淋巴结清扫术患者,按随机数字表法分为49例对照组和41例研究组。对照组采用常规静吸复合麻醉,研究组在常规静吸复合麻醉基础上应用右美托咪定。比较2组麻醉恢复质量、手术前后应激反应、T淋巴细胞亚群、血流动力学和不良反应发生情况。结果2组自主呼吸恢复时间、眨眼时间、拔管时间及定向力恢复时间比较差异无统计学意义(P>0.05)。术前,2组应激反应比较差异无统计学意义(P>0.05);术后24 h,2组皮质醇(Cor)、肾上腺素(NE)、去甲肾上腺素(NA)及血糖(GLU)均上升,但研究组低于对照组(P<0.05)。术前,2组T淋巴细胞亚群比较无统计学差异(P>0.05);术后24 h,2组CD3^+、CD4^+、CD4^+/CD8^+均下降,CD8^+均上升,但研究组较对照组变化幅度更小(P<0.05)。拔管时,2组平均动脉压(MAP)、心率(HR)均上升,但研究组低于对照组(P<0.05)。2组均有低血压、口干、恶心呕吐及寒战发生,总不良反应发生率比较差异无统计学意义(P>0.05)。结论右美托咪定复合七氟烷可促进术后恢复,减轻子宫肿瘤切除术患者围手术期的应激反应,且对T淋巴细胞亚群功能影响较小。

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on perioperative stress response and T lymphocyte subsets in patients undergoing hysterectomy.Methods 90 cases of cervical cancer patients,according to random number table method,were divided into 49 cases in the control group and 41 cases of the research group,the control group used conventional static absorption compound anesthesia,the research group used dexmedetomidine based on conventional static west compound anesthesia.The quality of anesthesia recovery,stress response before and after surgery,T lymphocyte subsets,hemodynamics and adverse reactions were compared between the 2 groups.Results There was no significant difference in the recovery time of spontaneous breathing,blink time,extubation time and directional force recovery time between the 2 groups(P>0.05).Before surgery,there was no statistically significant difference in the stress response between the 2 groups(P>0.05).24 h after the operation,cortisol(Cor),epinephrine(NE),norepinephrine(NA)and blood glucose(GLU)all increased in the 2 groups,and the research group was lower than the control group,the difference was statistically significant.(P<0.05).Before surgery,there was no statistically significant difference in T lymphocyte subsets between the 2 groups(P>0.05).At 24 h after the operation,CD3^+,CD4^+and CD4^+/CD8^+in both groups decreased,while CD8^+increased,the research group showed even less variation(P<0.05).When extubating,the mean arterial pressure(MAP)and heart rate(HR)in both groups increased,and the research group was lower than the control group(P<0.05).Hypotension,dry mouth,nausea,vomiting and chills occurred in both groups,and there was no statistically significant difference in the incidence of total adverse reactions(P>0.05).Conclusion Dexmedetomidine combined with sevoflurane can promote postoperative recovery,reduce perioperative stress response in patients undergoing hysterectomy and tumor removal,and has little effect on T lymphocyte subgroup function.