七氟烷吸入合右美托咪定对腹腔镜胆囊切除术患者血流动力学、氧化应激和Th1/Th2平衡的影响

Effects of Sevoflurane Inhalation Combined with Dexmedetomidine on Hemodynamics,Oxidative Stress and Th1/Th2 Balance in Patients Undergoing Laparoscopic Cholecystectomy

目的:探讨七氟烷吸入联合右美托咪定对腹腔镜胆囊切除术(LC)患者血流动力学、氧化应激和Th1/Th2平衡的影响。方法:选择我院2020年1月~2021年10月期间收治的LC患者98例,根据随机数字表法分为对照组(n=49,七氟烷吸入联合瑞芬太尼麻醉)和联合组(n=49,对照组基础上联合右美托咪定麻醉)。对比两组血流动力学、氧化应激和Th1/Th2平衡相关指标、术后疼痛情况,记录两组不良反应发生率。结果:手术进镜时(T1)~撤镜时(T3)时间点,两组心率(HR)、平均动脉压(MAP)先下降后升高,且联合组低于对照组同时间点(P<0.05)。术毕(T4)~术后24h(T5)时间点,两组丙二醛(MDA)、活性氧簇(ROS)水平先升高后下降,且联合组低于对照组同时间点(P<0.05);T4~T5时间点,两组超氧化物歧化酶(SOD)水平先下降后升高,且联合组高于对照组同时间点(P<0.05)。T4~T5时间点,对照组γ-干扰素(TFN-γ)水平、TFN-γ/白介素-4(IL-4)比值下降,IL-4水平升高(P<0.05);T4~T5时间点,联合组TFN-γ水平、TFN-γ/IL-4比值升高,IL-4水平下降(P<0.05);T4~T5时间点,联合组的TFN-γ水平、TFN-γ/IL-4比值高于对照组,IL-4水平低于对照组(P<0.05)。术后6 h~术后24 h,两组视觉模拟量表(VAS)评分先升高后下降,且联合组低于对照组同时间点(P<0.05)。两组不良反应发生率组间对比无差异(P>0.05)。结论:七氟烷吸入联合右美托咪定用于LC患者,可减轻机体氧化应激程度,维持血流动力学稳定,改善Th1/Th2平衡,镇痛效果好,且不会增加不良反应发生率。

Objective:To investigate the effects of sevoflurane inhalation combined with dexmedetomidine on hemodynamics,oxidative stress and Th1/Th2 balance in patients undergoing laparoscopic cholecystectomy(LC).Methods:98 patients with LC who were treated in our hospital from January 2020 to October 2021 were selected,according to the random number table method,they were divided into control group(n=49,sevoflurane inhalation combined with remifentanil anesthesia) and combined group(n=49,control group combined with dexmedetomidine anesthesia).Hemodynamics,oxidative stress,Th1/Th2 balance and postoperative pain situation were compared between the two groups,and the incidence of adverse reactions was recorded.Results:The heart rate(HR) and mean arterial pressure(MAP) of the two groups decreased first and then increased at the time point from endoscopic entry(T1) to endoscopic withdrawal(T3) time points,and the combined group was lower than the control group at the same time point(P0.05).Conclusion:Sevoflurane inhalation combined with dexmedetomidine for patients with LC can reduce oxidative stress,maintain hemodynamic stability,improve Th1/Th2 balance,and have good analgesic effect without increasing the incidence of adverse reactions.