依托咪酯靶控输注联合右美托咪定对胃癌根治术患者应激反应、炎症因子和细胞免疫功能的影响

Effects of Etomidate Target Controlled Infusion Combined with Dexmedetomidine on Stress Response,Inflammatory Factors and Cellular Immune Function in Patients Undergoing Radical Gastrectomy for Gastric Cancer

目的:观察胃癌根治术患者在依托咪酯靶控输注联合右美托咪定麻醉下,机体细胞免疫功能、炎症因子、应激反应的影响。方法:选取2021年4月~2022年6月期间我院收治的择期行胃癌根治术患者100例,按照信封抽签的形式将患者分为对照组(n=50)和观察组(n=50),对照组患者麻醉选用依托咪酯注射液靶控输注,观察组则在对照组的基础上结合静脉输注盐酸右美托咪定注射液。观察两组患者不良反应发生情况、血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)]、应激反应指标[皮质醇(Cor)、肾上腺素(E)、促肾上腺皮质激素(ACTH)]、炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]、细胞免疫功能指标。结果:观察组用药时、拔管时SBP、HR、DBP低于对照组(P<0.05)。两组不良反应发生率组间对比无差异(P>0.05)。观察组术后1 d E、IL-6、Cor、TNF-α、ACTH、hs-CRP、CD8^(+)低于对照组(P<0.05)。观察组术后1 d CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05)。结论:胃癌根治术患者使用依托咪酯靶控输注联合右美托咪定麻醉,血流动力学、应激反应可得到有效控制,炎症因子、免疫功能的影响也可大大减轻,利于手术的顺利进行。

Objective:To observe the effects of etomidate target controlled infusion combined with dexmedetomidine anesthesia on cellular immune function,inflammatory factors and stress response in patients undergoing radical gastrectomy for gastric cancer.Methods:100 patients with gastric cancer who were selected for radical gastrectomy in our hospital from April 2021 to June 2022 were selected,and they were divided into control group (n=50) and observation group(n=50) according to the form of envelope lottery.Patients in control group were anesthetically treated with etomidate injection target controlled infusion.The observation group was combined with dexmedetomidine hydrochloride injection intravenous infusion on the basis of the control group.The occurrence of adverse reactions in patients,hemodynamic indexes[heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP)],stress response indexes[cortisol (Cor),epinephrine (E),adrenocorticotropic hormone (ACTH)],inflammatory factors[tumor necrosis factor-α (TNF-α),interleukin-6(IL-6),high sensitivity C-reactive protein(hs-CRP)],cellular immune function indexes of the two groups were observed.Results SBP,HR and DBP in the observation group were lower than those in the control group at the time of medication and at the time of extubation (P0.05).1 d after operation,E IL-6,Cor,TNF-α,ACTH,hs-CRP and CD8^(+)in the observation group were lower than those in the control group (P<0.05).The CD4^(+)CD3^(+)and CD4^(+)/CD8^(+)in the observation group at 1 d after operation were higher than those in the control group (P<0.05).Conclusion For patients undergoing radical gastrectomy for gastric cancer with etomidate target controlled infusion combined with dexmedetomidine anesthesia,the hemodynamics and stress response can be effectively controlled,and the influence of inflammatory factors and immune function can be greatly reduced,which is conducive to the smooth operation.