右美托咪定联合丙泊酚麻醉对胃癌根治术患者术后镇痛及细胞免疫功能的影响

Effects of dexmedetomidine combined with propofol on postoperative analgesia and cellular immune function in patients undergoing laparoscopic radical gastrectomy

目的探讨右美托咪定联合丙泊酚全凭静脉麻醉(TIVA)对腹腔镜胃癌根治术患者术后疼痛、应激反应、不良反应及免疫功能的影响。方法选取兰州大学第二医院2021-03/2023-12期间行腹腔镜胃癌根治术患者100例,采用随机数字表法分为丙泊酚组(对照组,n=50)和右美托咪定联合丙泊酚组(联合组,n=50)。对照组泵入等量生理盐水;联合组麻醉诱导前静脉泵入1μg/kg右美托咪定10 min。麻醉维持2组均采用TIVA,联合组术中持续泵入右美托咪定0.4μg(/kg·h)。观察术后并发症,进行Ramsay镇静评分、VAS疼痛评分,并采集术前1 h和术后24 h血液,检测血清应激指标及外周血细胞免疫功能指标。结果联合组患者术后1 h Ramsay评分、术前1 h和术后24 h的血清应激指标及血液细胞免疫功能指标均高于对照组,差异有统计学意义(P<0.05),而术后1 h VAS评分和麻醉相关并发症总发生率均低于对照组,差异有统计学意义(P<0.05)。结论右美托咪定联合丙泊酚行腹腔镜胃癌根治术的麻醉效果优于单纯丙泊酚,患者术后细胞免疫功能恢复加快,术后应激反应和疼痛等不良反应减少。

Objective To investigate the effects of dexmedetomidine combined with propofol for total intravenous anesthesia(TIVA)on postoperative pain,stress response,adverse reactions and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods A total of 100 patients who underwent laparoscopic radical gastrectomy in Lanzhou University Second Hospital from March 2021 to December 2023 were divided into the propofol group(control group,n=50)and dexmedetomidine combined with propofol group(combined group,n=50)according to random number table method.Patients in the combined group were intravenous infused with 1μg/kg dexmedetomidine for 10 min,and patients in the control group were intravenous infused with the same volume of normal saline.Both groups were treated by TIVA.The combined group received dexmedetomidine infusion at a rate of 0.4μg/(kg·h).The occurrence of postoperative complications were observed.Ramsay sedation score and VAS pain score were performed.Blood samples 1 h before surgery and 24 h after sugery were collected,serum stress indexes were detected by radioimmunoassay,and cellular immune function indexes were detected by flow cytometry.Results The Ramsay scores at 1h after surgery,serum stress indexes and blood cell immune function indexes at 1h before sugery and 24 h after surgery in the group were higher than those in the control group(P<0.05),with statistical significance.While the VAS score at 1 h after surgery and the total incidence of anesthesia-related complications were lower than those in the control group(P<0.05),with statistical significance.Conclusion The anesthetic effect of dexmedetomidine combined with propofol is better than that of propofol alone in laparoscopic radical gastrectomy for gastric cancer,which is more conducive to the recovery of postoperative cellular immune function,the reduction of postoperative stress reaction,pain and adverse reactions.