右美托咪定在老年肝癌围术期炎症抑制和预后方面的作用

Role of Dexmedetomidine in Perioperative Inflammation Inhibitionand Prognosis in Elderly Hepatocellular Carcinoma

目的:评价右美托咪定在老年患者行肝脏切除手术围术期的炎症抑制方面及早期康复方面的作用。方法:择期拟行肝切除术的老年患者150例,性别不限,BMI 18.5~24.9kg/m2,65~80岁,ASA分级Ⅱ或Ⅲ级,Child-pugh分级A或B级。采用随机数字表简单随机把入选病例分成两部分:试验组和对照组,每组各75例。试验组持续泵注右美托咪定0.2μg·kg^(-1)·h^(-1),维持至手术结束前30min;对照组以相同速度静脉泵入相同剂量0.9%氯化钠。记录患者入室(T_(0))、切皮(T_(1))、开始切肝(T_(2))、切肝完成(T_(3))、术毕(T_(4))的MAP、HR。于入室(T_(0))、手术结束(T_(4))、术后第1天(T_(5))抽取颈内静脉血4ml,测量炎症因子水平,分析比较两组手术相关情况、炎症免疫因子水平变化,住院时间、术后疼痛最高分(VAS评法)及继发恶性效应比率。结果:试验组在T_(2)、T_(3)的MAP波动幅度较小,而T_(2)、T_(3)时刻的HR比对照组显著降低,比较差异具有统计学意义(P<0.05)。试验组T_(5)免疫炎症及趋化因子水平明显优于本组T_(0)、T_(4);试验组T_(4)、T_(5)的SDF-1、TNF-α、IL-6、CRP指标水平以显著低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)和NK细胞表达显著高于对照组;试验组T_(4)的CjvO_(2)、Da-jvO_(2)、CERO_(2)显著低于对照组;术后试验组住院天数、术后疼痛最高分(VAS评法)明显低于对照组,术后两组继发恶性效应比率没有明显差异。结论:右美托咪定能维持循环系统稳定,减少手术创伤导致的炎症趋化聚集,减轻炎症反应,促进患者早期康复,减少在院治疗天数,适合广泛施行。

Objective:To evaluate the role of dexmedetomidine in the perioperative inhibition of inflammation and early recovery in elderly patients undergoing hepatectomy.Methods:One hundred and fifty elderly patients,regardless of gender,with BMI 18.5 to 24.9 kg/m^(2),65 to 80 years old,ASA grade II or III,and Child-pugh grade A or B,were proposed for elective hepatectomy.A random number table was used to simply randomly divide the enrolled cases into two parts:an experimental group and a control group,each with 75 cases.In the experimental group,dexmedetomidine 0.2μg/μg·kg^(-1)·h^(-1),was continuously pumped and maintained until 30 min before the end of surgery;in the control group,the same dose of 0.9%NaCl was pumped intravenously at the same rate.The MAP and HR were recorded at room entry(T_(0)),skin incision(T_(1)),start of liver incision(T_(2)),completion of liver incision(T_(3)),and end of surgery(T_(4)).4 ml of blood was drawn from the internal jugular vein at room entry(T_(0)),end of surgery(T_(4)),and the first day after surgery(T_(5))to measure the level of inflammatory factors and to analyze and compare the surgical-related conditions,changes in inflammatory immune factor levels,length of hospital stay,and postoperative pain between the two groups.The highest scores(VAS scale)and the ratio of secondary malignant effects were analyzedand compared between the two groups.Results:The MAP fluctuations of the experimental group at T_(2) and T_(3) were smaller,while the HR at the moment of T_(2) and T_(3) was significantly lower than that of the control group,and the comparative differences were statistically significant(P<0.05).The levels of immune inflammation and chemokines in the test group T_(5) were significantly better than those in this group T0 and T_(4);the levels of SDF-1,TNF-α,IL-6 and CRP indexes in the test group T_(4) and T_(5) were significantly lower than those in the control group,and the expression of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and NK cells were significantly higher than those in the control group;the levels of CjvO_(2),Da-jvO_(2),CERO_(2) in the test group T_(4) were significantly lower than those in the control group;the number of postoperative hospitalization days and the highest postoperative pain score(VAS rating)in the test group were significantly lower than those in the control group,and there was no significant difference in the ratio of secondary malignant effects between the two groups after surgery.Conclusion:Dexmedetomidine can maintain circulatory stability,reduce inflammatory convergence due to surgical trauma,reduce inflammatory response,promote early recovery,reduce the number of days in hospital,and is suitable for widespread implementation.