妇科肿瘤患者腹腔镜手术麻醉前应用右美托咪定减轻肠屏障功能损伤及SIRT1在其中的可能作用

Effect of dexmedetomidine used before anesthesia on reduction of intestinal barrier function impairment in gynecologic neoplasms patients undergoing laparoscopic surgery and the possible role of SIRT1 in it

目的探讨右美托咪定(DEX)对妇科肿瘤患者腹腔镜手术肠屏障功能损伤的影响及沉默信息调节因子1(SIRT_(1))在此过程中的可能作用。方法前瞻性随机对照研究。前瞻性选取2022年5月至2023年5月山西医科大学第二医院拟在全身麻醉下行妇科肿瘤腹腔镜手术的40例患者,采用随机数字表法将患者分为试验组和对照组,每组20例。试验组常规麻醉诱导前给予DEX负荷剂量0.5μg/kg(10 min内静脉泵入),随后以0.2μg·kg^(-1)·h^(-1)维持至手术结束前30 min;对照组静脉泵入与试验组相同剂量的0.9%氯化钠注射液。分别于麻醉诱导前10 min(T_(1))、解除气腹后1 h(T_(2))、解除气腹后24 h(T_(3))取上肢外周静脉血5 ml,用酶联免疫吸附试验检测血清中SIRT_(1)及封闭蛋白1(Claudin-1)蛋白表达水平,比较两组患者血清SIRT_(1)、Claudin-1蛋白水平及术后首次排气时间。结果两组患者年龄、体质量指数、气腹时间、手术时间及麻醉时间比较,差异均无统计学意义(均P>0.05)。T_(1)时,对照组和试验组SIRT_(1)[(10.2±1.5)ng/ml比(10.0±1.3)ng/ml,t=0.46,P=0.468]、Claudin-1[(405±45)pg/ml比(404±40)pg/ml,t=0.13,P=0.901]蛋白浓度差异均无统计学意义;T_(2)时,试验组SIRT_(1)[(8.4±1.3)ng/ml比(6.1±1.3)ng/ml,t=-5.55,P<0.001]、Claudin-1[(383±39)pg/ml比(331±44)pg/ml,t=-4.02,P<0.001]蛋白浓度均高于对照组,两组差异均有统计学意义;T_(3)时,试验组SIRT_(1)[(8.4±1.2)ng/ml比(6.7±1.1)ng/ml,t=-4.56,P<0.001]、Claudin-1[(388±40)pg/ml比(341±43)pg/ml,t=-3.63,P<0.001]蛋白浓度均高于对照组,两组差异均有统计学意义。试验组术后首次排气时间短于对照组[(21.7±2.2)h比(27.9±3.4)h],差异有统计学意义(t=6.78,P<0.001)。结论右美托咪定可能通过激活SIRT_(1)减轻妇科肿瘤患者腹腔镜手术引起的肠上皮细胞损伤,对肠屏障功能起到一定的保护作用。

Objective To investigate the effect of dexmedetomidine(DEX)on intestinal barrier function impairment in gynecologic neoplasms patients undergoing laparoscopic surgery and the possible role of silent information regulator 1(SIRT_(1))in this process.Methods A prospective randomized controlled study was conducted.Forty patients who were to undergo laparoscopic surgery of gynecologic neoplasms under general anesthesia in the Second Hospital of Shanxi Medical University from May 2022 to May 2023 were prospectively selected.All patients were divided into the experimental group and the control group using the method of randomized numerical table,with 20 cases in each group.The experimental group was given a loading dose of DEX 0.5μg/kg(intravenously pumped in 10 min)before induction of general anesthesia,and then maintained with DEX 0.2μg·kg^(-1)·h^(-1)until 30 min before the end of surgery.In the control group,the same dose of 0.9%sodium chloride injection was pumped intravenously.Taking 5 ml of peripheral venous blood from the upper extremities 10 min before induction of anesthesia(T_(1)),1 h after the release of pneumoperitoneum(T_(2))and 24 h after the release of pneumoperitoneum(T_(3)),respectively,the serum levels of SIRT_(1)and Claudin-1 proteins were measured by enzyme-linked immunosorbent assay.Then the concentrations of SIRT_(1)and Claudin-1 proteins and the time of first postoperative exhaust in the two groups of patients were compared.Results The differences in age,body mass index,pneumoperitoneum time,operation time and anesthesia time between the two groups were not statistically significant(all P>0.05).At T_(1),there was no statistically significant difference in concentrations of SIRT_(1)[(10.2±1.5)ng/ml vs.(10.0±1.3)ng/ml,t=0.46,P=0.468]and Claudin-1[(405±45)pg/ml vs.(404±40)pg/ml,t=0.13,P=0.901]proteins between the control group and the experimental group.At T_(2),the concentrations of SIRT_(1)[(8.4±1.3)ng/ml vs.(6.1±1.3)ng/ml,t=-5.55,P<0.001]and Claudin-1[(383±39)pg/ml vs.(331±44)pg/ml,t=-4.02,P<0.001]proteins in the experimental group were higher than those in the control group,the differences were statistically significant.At T_(3),the concentrations of SIRT_(1)[(8.4±1.2)ng/ml vs.(6.7±1.1)ng/ml,t=-4.56,P<0.001]and Claudin-1[(388±40)pg/ml vs.(341±43)pg/ml,t=-3.63,P<0.001]proteins in the experimental group were higher than those in the control group,the differences were statistically significant.The time of first postoperative exhaust in the experimental group was shorter than that in the control group[(21.7±2.2)h vs.(27.9±3.4)h],and the difference was statistically significant(t=6.78,P<0.001).Conclusions Dexmedetomidine may reduce the intestinal epithelial cell injury induced by laparoscopic surgery in patients with gynecologic neoplasms via activating SIRT_(1),and exert a protective effect on intestinal barrier function.