右美托咪定对腹腔镜结肠癌根治术患者围术期应激反应及免疫功能的影响

Effects of dexmedetomidine on stress response and immune function of patients at perioperative period of laparoscopic colon cancer resection

目的探讨右美托咪定对腹腔镜结肠癌根治术患者围术期应激反应及免疫功能的影响。方法120例结肠癌患者,采用随机数字表法随机分为右美托咪定组(D组)和对照组(C组),每组60例。2组患者均行腹腔镜结肠癌根治术。D组在常规麻醉方法的基础上,麻醉诱导前10 min,静脉泵注右美托咪定0.6μg/kg,术中维持剂量0.5μg·kg^-1·h^-1直至手术结束前30 min,C组泵注同等容量的0.9%氯化钠溶液。术后常规静脉自控镇痛(patient controlled intravenous analgesia,PCIA),D组药物组成中加入右美托咪定2μg/kg。比较2组患者手术情况,围术期氧化应激和免疫水平。结果2组患者术后首次排气时间比较,差异有统计学意义(P<0.05)。2组患者手术开始后1 h(T1),术毕即刻(T2)和术后24 h(T3)时间点的去甲肾上腺素,肾上腺素及皮质醇水平比较,差异均有统计学意义(P<0.05)。2组患者T2和T3时间点的CD^+3,CD^+4,CD^+4/CD^+8和自然杀伤细胞水平比较,差异有统计学意义(P<0.05)。2组患者PCIA自控给药次数和术后24 h,术后48 h的视觉模拟评分比较,差异有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定能够有效减轻腹腔镜结肠癌根治术患者机体的应激反应,改善患者免疫功能,缓解患者术后疼痛情况,促进肠功能恢复,利于术后恢复。

Objective To investigate the effects of dexmedetomidine on stress response and immune function of patients at perioperative period of laparoscopic colon cancer resection.Methods A total of 120 patients with colon cancer were randomly divided into two groups:dexmedetomidine group(group D)and control group(group C),with 60 cases in each group.All the patients received laparoscopic colorectal cancer radical operation.On the basis of conventional anesthesia,the patients in group D were given intravenous infusion of dexmedetomidine 0.6μg/kg,10 minutes before anesthesia induction,and 0.5μg·kg^-1·h^-1 Maintenance dose until 30 minutes before the end of operation.However the patients in group C were given equivalent 0.9%sodium chloride solution.The patients in both groups underwent patient controlled intravenous analgesia(PCIA),drug composition contained dexmedetomidine 2μg/kg in group D.The operative condition,oxidative stress and immune levels at perioperative period of laparoscopic colon cancer resection were observed and compared between the two groups.Results There was significant difference in first exhaust time(P<0.05).There were significant differences in the levels of norepinephrine(NE),Epinephrine(E)and Cortisol(Cor)at T1,T2 and T3 between the two groups(P<0.05).There were significant differences in the levels of CD^+3,CD^+4,CD^+4/CD^+8 and natural killer cell(NK)at T2 and T3 between the two groups(P<0.05).There were significant differences in PCIA administration frequency,visual analogue scale(VAS)scores at 24h and 48h after operation between the two groups(P<0.05).In addition there was no significant difference in the incidence rate of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine can effectively reduce the stress response,improve the immune function,relieve the postoperative pain,promote the recovery of intestinal function,and facilitate the postoperative recovery of patients.