右美托咪定对卵巢恶性肿瘤患者围术期凝血功能及炎性因子的影响

Effects of dexmedetomidine on perioperative coagulation function and inflammatory factors in patients with malignant ovarian tumors

目的:探讨右美托咪定对卵巢恶性肿瘤患者围术期凝血功能及炎性因子的影响。方法:选取山西医科大学第二医院2019年9月至2020年5月拟行卵巢恶性肿瘤细胞减灭术患者60例,根据随机数字表法将患者分为右美托咪定组和对照组,每组30例。右美托咪定组患者于麻醉诱导前10 min泵注右美托咪定0.5μg/kg,后以0.2~0.6μg·kg-1·h-1维持静脉泵注,至手术完毕前30 min结束泵注。对照组同时段泵注相同容量的0.9%NaCl溶液。在麻醉诱导前(T 0)、给药2 h后(T_(1))、术后3 h(T_(2))采集患者静脉血,检测血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、D-二聚体,并检测血清炎性因子白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平。比较两组患者手术时间、术中输液量、麻醉药物用量、术中总失血量。结果:右美托咪定组T_(1)、T_(2)时刻Plt分别为(154±28)×10^(9)/L、(138±27)×10^(9)/L,对照组分别为(133±44)×10^(9)/L、(114±50)×10^(9)/L,均低于两组T 0时刻[(182±46)×10^(9)/L、(184±55)×10^(9)/L],差异均有统计学意义(F值分别为11.975、16.058,均P<0.01),且对照组T_(1)、T_(2)时刻均低于右美托咪定组(均P<0.05)。右美托咪定组和对照组T_(1)、T_(2)时刻FIB水平[右美托咪定组:(3.2±0.9)g/L、(3.3±0.9)g/L,对照组:(3.7±0.6)g/L、(4.6±0.9)g/L]及D-二聚体水平[右美托咪定组:(0.77±0.25)mg/L、(0.81±0.51)mg/L,对照组:(0.96±0.31)mg/L、(1.15±0.56)mg/L],均高于两组相应的T 0时刻[FIB:(3.0±0.7)g/L、(2.8±0.6)g/L,D-二聚体:(0.65±0.19)mg/L、(0.63±0.39)mg/L],差异均有统计学意义(F值分别为5.234、46.121、4.358、11.091,均P<0.05),且对照组T_(1)、T_(2)时刻FIB和D-二聚体水平均高于右美托咪定组(均P<0.05)。右美托咪定组T_(2)时刻PT、APTT分别为(12.7±0.5)s、(33.8±3.7)s,对照组分别为(12.3±0.8)s、(31.8±2.4)s,均短于两组相应的T 0时刻[PT:(13.0±0.3)s、(13.0±0.3)s,APTT:(35.7±2.0)s、(35.7±2.6)s],差异均有统计学意义(均P<0.05),且对照组T_(2)时刻均短于右美托咪定组(均P<0.05)。右美托咪定组和对照组T_(1)、T_(2)时刻IL-6水平[右美托咪定组:(73.3±2.8)pg/L、(84.7±3.8)pg/L,对照组:(81.5±3.6)pg/L、(89.8±3.2)pg/L]及TNF-α水平[右美托咪定组:(27.6±4.6)ng/L、(32.9±3.7)ng/L,对照组:(32.7±2.5)ng/L、(39.8±4.0)ng/L]均高于两组相应的T 0时刻[IL-6:(65.9±2.9)pg/L、(65.0±1.8)pg/L,TNF-α:(15.4±3.1)ng/L、(16.6±2.6)ng/L)],差异均有统计学意义(F值分别为264.650、553.019、162.447、438.225,均P<0.05),且对照组T_(1)、T_(2)时刻IL-6和TNF-α水平均高于右美托咪定组(均P<0.05)。两组患者手术时间、术中输液量、术中总失血量差异均无统计学意义(均P>0.05),但对照组术中丙泊酚、瑞芬太尼的用量均多于右美托咪定组(均P<0.05)。结论:卵巢恶性肿瘤手术患者在全身麻醉下应用右美托咪定,可有效改善围术期凝血功能,并降低炎性因子水平,从而降低术后血栓事件发生风险。

Objective To investigate the effects of dexmedetomidine on perioperative coagulation function and inflammatory factors in patients with malignant ovarian tumors.Methods A total of 60 patients undergoing cytoreductive surgery for malignant ovarian tumors from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and divided into the dexmedetomidine group and the control group according to the random number table method,30 cases in each group.Patients in the dexmedetomidine group were pumped with dexmedetomidine 0.5μg/kg 10 min before induction of anesthesia,and then the intravenous pump was maintained at a rate of 0.2-0.6μg·kg-1·h-1 until 30 min before the completion of the operation pump injection.The control group was pumped with 0.9%NaCl solution of the same volume at the same time.Before induction of anesthesia(T0),2 h after administration(T_(1)),and 3 h after operation(T_(2)),the patients'venous blood was collected to detect platelet count(Plt),prothrombin time(PT),activated partial thrombin time(APTT),plasma fibrinogen(FIB),D-dimer;and levels of serum inflammatory factors interleukin 6(IL-6)and tumor necrosis factorα(TNF-α)were also detected.The operation time,intraoperative fluid infusion,amount of anesthetics,and total intraoperative blood loss were compared between the two groups.Results Plt at T_(1)and T_(2)time were(154±28)×10^(9)/L,(138±27)×10^(9)/L of the dexmedetomidine group and(133±44)×10^(9)/L,(114±50)×10^(9)/L of the control group,which were lower than those of both groups at T0 time[(182±46)×10^(9)/L,(184±55)×10^(9)/L],and the differences were statistically significant(F values were 11.975,16.058,all P<0.05);and Plt at T_(1)and T_(2)time of the control group were lower than those of the dexmedetomidine group(all P<0.05).FIB level at T_(1)and T_(2)time[(3.2±0.9)g/L,(3.3±0.9)g/L of the dexmedetomidine group;(3.7±0.6)g/L,(4.6±0.9)g/L of the control group]and D-dimer level at T_(1)and T_(2)time[(0.77±0.25)mg/L,(0.81±0.51)mg/L of the dexmedetomidine group;(0.96±0.31)mg/L,(1.15±0.56)mg/L of the control group]were higher than those of both groups at T0 time[FIB:(3.0met)g/L,(2.8 met)g/L;D-dimer:(0.65rt T)mg/L,(0.63 rt T)mg/L],and the differences were statistically significant(F values were 5.234,46.121,4.358,11.091,all P<0.05);FIB and D-dimer levels at T_(1)and T_(2)time of the control group were higher than those of the dexmedetomidine group(all P<0.05).PT and APTT at T_(2)time of the dexmedetomidine group were(12.7±0.5)s and(33.8±3.7)s,respectively,and the control group were(12.3±0.8)s,(31.8±2.4)s,respectively,which were shorter than those of both groups at T0 time[PT:(13.0±0.3)s,(13.0±0.3)s;APTT:(35.7±2.0)s,(35.7±2.6)s],and the differences were statistically significant(all P<0.05),and PT and APTT levels at T_(2)time of the control group were shorter than those of the dexmedetomidine group(all P<0.05).IL-6 level at T_(1)and T_(2)time[(73.3±2.8)pg/L,(84.7±3.8)pg/L of the dexmedetomidine group;(81.5±3.6)pg/L,(89.8±3.2)pg/L of the control group]and TNF-αlevel at T_(1)and T_(2)time[(27.4±4.4)ng/L,(32.9±3.7)ng/L of the dexmedetomidine group;(32.7±2.5)ng/L,(39.8±4.0)ng/L of the control group]were higher than those of both groups at T0 time[IL-6:(65.9±2.9)pg/L,(65.0±1.8)pg/L;TNF-α:(15.4±3.1)ng/L,(16.6±2.6)ng/L)],and the differences were statistically significant(F values were 264.650,553.019,162.447,and 438.225,respectively,all P<0.05),and IL-6 and TNF-αlevels at T_(1)and T_(2)time of the control group were higher than those of the dexmedetomidine group(all P<0.05).There were no statistically significant differences in operation time,intraoperative fluid infusion,and intraoperative total blood loss between the two groups(all P>0.05),but the intraoperative use of propofol and remifentanil of the control group was more than that of the dexmedetomidine group(all P<0.05).Conclusion Dexmedetomidine under general anesthesia for malignant ovarian patients undergoing surgery can effectively improve the perioperative coagulation function and reduce the level of inflammatory factors,thereby reducing the risk of postoperative thrombotic events.