右美托咪定联合地佐辛对乳腺癌手术患者血流动力学 炎性因子 应激反应及术后麻醉恢复的影响

Effects of dexmedetomidine combined with dezocine on hemodynamics,inflammatory factors,stress reaction and postoperative anesthesia recovery in breast cancer patients

目的探讨右美托咪定联合地佐辛对乳腺癌手术患者血流动力学、炎性因子、应激反应及术后麻醉恢复的影响。方法将拟行乳腺癌根治术的90例患者按随机数字表法分为联合组、右美托咪定组、地佐辛组,各30例。3组均在气管插管全麻下行乳腺癌根治术治疗,在麻醉诱导前右美托咪定组予以右美托咪定镇痛镇静,地佐辛组予以地佐辛镇痛镇静,联合组予以右美托咪定联合地佐辛镇痛镇静。比较3组T0(术前)、T1(手术切皮)、T2(手术开始后1 h)、T3(术毕)时点血流动力学指标(平均动脉压、心率),T0、T3、T4(术后12 h)、T5(术后24 h)时点血清炎性因子指标(肿瘤坏死因子-α、白细胞介素-6、C反应蛋白)、应激反应指标(血管紧张素Ⅱ、皮质醇、醛固酮)、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平以及麻醉恢复情况、不良反应发生率。结果(1)血流动力学:联合组T1、T2、T3时点平均动脉压、心率与T0时点比较差异无统计学意义(P>0.05),均显著低于右美托咪定组、地佐辛组(P<0.05或0.01);右美托咪定组、地佐辛组T1、T2、T3时点平均动脉压、心率均较T0时点显著升高(P<0.05或0.01)。(2)炎性因子:3组T3、T4、T5时点血清肿瘤坏死因子-α、白细胞介素-6、C反应蛋白水平均较T0时点显著升高(P<0.05或0.01),联合组显著低于右美托咪定组、地佐辛组(P<0.01)。(3)应激反应:T3、T4时点3组血清血管紧张素Ⅱ、皮质醇、醛固酮水平较T0时显著增高(P<0.05或0.01),T5时点右美托咪定组、地佐辛组血清血管紧张素Ⅱ水平较T0时显著增高(P<0.01),联合组较T0时点无显著变化(P>0.05);T3、T4、T5时点联合组血清血管紧张素Ⅱ、皮质醇、醛固酮水平显著低于右美托咪定组、地佐辛组(P<0.05或0.01)。(4)免疫功能:3组T3、T4、T5时点血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较T0时点显著降低(P<0.01),联合组显著高于右美托咪定组、地佐辛组(P<0.05或0.01)。(5)术后麻醉恢复及不良反应:3组气管拔管时间、麻醉苏醒时间、呼吸恢复时间及不良反应发生率比较差异均无统计学意义(P>0.05)。结论右美托咪定联合地佐辛可有效维护乳腺癌手术患者血流动力学稳定,减轻炎性应激反应与免疫抑制,且对术后麻醉恢复无明显影响,具有良好的麻醉效果及安全性。

Objective To investigate the effects of dexmedetomidine(Dex)combined with dezocine(Dez)on hemodynamics,inflammatory factors,stress reaction and postoperative anesthesia recovery in breast cancer patients.Methods A total of 90 patients undergoing radical mastectomy for breast cancer were selected and divided into a combined group(n=30),a Dex group(n=30),and a Dez group(n=30)with a random number table.All groups were treated with endotracheal intubation for general anesthesia.The Dex group was given Dex before anesthesia induction,the Dez group was given Dez before anesthesia induction,and the combined group was given Dex combined with Dez.The hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR)]before operation(T0),when the skin was cut(T1),1 h after the start of the operation(T2),and after the operation(T3),serum inflammatory factor indexes[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],stress response indicators[angiotensinⅡ(AngⅡ),cortisol(Cor),aldosterone(ALD)],and immune function indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))levels at T0,T3,12 h after operation(T4),and 24 h after operation(T5),and the recovery of anesthesia and adverse reactions of the three groups were compared.Results(1)Hemodynamics:Compared with T0,there was no significant change in MAP and HR levels in T1,T2,T3 of the combined group(P>0.05),and were significantly lower than those in the Dex group and the Dez group(P<0.05 or 0.01).Compared with T0,MAP and HR at T1,T2,T3 in the Dex group and the Dez group were significantly increased(P<0.05 or 0.01).(2)Inflammatory factor:The levels of serum TNF-α,IL-6 and CRP in the three groups at T3,T4,T5 were significantly higher than those at T0(P<0.05 or 0.01).The combined group was significantly lower than the Dex group and the Dez group(P<0.01).(3)Stress response:Compared with T0,AngⅡ,Cor and ALD in the three groups at T3,T4 were significantly increased(P<0.05 or 0.01).Serum AngⅡin the Dex group and the Dez group was significantly increased at T5 compared with T0(P<0.01),but there was no significant change in the combined group compared with T0(P>0.05).Serum AngⅡ,Cor and ALD levels in the combined group at T3,T4,T5 were significantly lower than those in the Dex group and the Dez group(P<0.05 or 0.01).(4)Immune function:Compared with T0,the levels of serum CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the three groups at T3,T4,and T5 were significantly reduced(P<0.01),and the combined group was significantly higher than those in the Dex group and the Dez group(P<0.05 or 0.01).(5)Postoperative anesthesia recovery and adverse reactions:There were no statistically significant differences in tracheal extubation time,anesthesia recovery time,respiratory recovery time,and incidence of adverse reactions among the three groups(P>0.05).Conclusions Dex combined with Dez can effectively maintain the intraoperative hemodynamic stability of patients undergoing breast cancer surgery,and at the same time reduce the body's inflammatory stress response and immune suppression,and does not affect the recovery of postoperative anesthesia.It has good anesthesia effect and safety.