右美托咪定在腹腔镜胆囊切除术患者中的应用价值及对糖萼的影响

The application value of dexmedetomidine in patients undergoing laparoscopic cholecystectomy and its effect on the glycocalyx

目的探讨全身麻醉诱导前使用右美托咪定对腹腔镜胆囊切除术患者术中血流动力学、术后镇痛、炎症因子及糖萼的影响。方法选取本院收治的因胆囊结石伴急性胆囊炎行全身麻醉下腹腔镜胆囊切除术的患者200例,随机分为观察组(100例)和对照组(100例)。对照组在全身麻醉诱导前静脉注入0.9%氯化钠溶液10 mL,而观察组注入右美托咪定(0.8μg/kg)。观察2组血流动力学、手术时间、麻醉时间、拔管时间、最小肺泡浓度=1的维持时间、术后疼痛程度、不良反应发生率、白细胞、白细胞介素(interleukins,IL)-1、IL-6、IL-8、肿瘤坏死因子α、C反应蛋白、降钙素原及糖萼损伤标志物(多聚糖蛋白聚糖1、硫酸乙酰肝素、透明质酸)情况。结果研究表明,2组患者在手术时间、麻醉时间、拔管时间等一般情况方面差异无统计学意义。但观察组能较好的维持术中血流动力学参数(P<0.05),且观察组术后3 h、6 h、9 h、12 h的VAS评分均显著低于对照组,在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。虽然2组术后白细胞值相当,但术后炎症因子和糖萼损伤标志物水平差异均有统计学意义(P<0.05)。观察组IL-1、IL-6、IL-8、肿瘤坏死因子α、C反应蛋白、降钙素原及糖萼损伤标志物显著低于对照组(P<0.05)。此外,观察组术后不良反应发生率明显低于对照组(P<0.05)。结论因胆囊结石伴急性胆囊炎行腹腔镜胆囊切除术患者在全身麻醉诱导前应用右美托咪定可较好的维持术中血流动力学参数,有效改善术后疼痛,减轻术后炎症和不良反应,同时能够抑制血管内皮糖萼的脱落,改善机体免疫功能,促进患者术后康复。

Objective To investigate the effects of dexmedetomidine before induction of general anesthesia on intraoperative hemodynamics,postoperative analgesia,inflammatory factors and glycocalyx in patients undergoing laparoscopic cholecystectomy.Methods A total of 200 patients with cholecystolithiasis complicated with acute cholecystitis undergoing laparoscopic cholecystectomy under general anesthesia in our hospital were randomly divided into an observation group(n=100)and a control group(n=100).In the control group,10 mL of 0.9%sodium chloride solution was injected intravenously before induction of general anesthesia,while dexmedetomidine(0.8μg/kg)was injected in the observation group.The hemodynamics,duration of operation,duration of anesthesia,time to extubation,duration of minimum alveolar concentration equal to 1,degree of postoperative pain,incidence of adverse effects,leukocyte values,interleukin(IL)-1,IL-6,IL-8,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin and glycocalyx injury markers(syndecan-1,heparan sulfate,hyaluronic acid)were observed in the two groups.Results This study showed that there was no difference between the two groups in terms of general characteristics such as duration of operation,duration of anesthesia,and time to extubation.However,the observation group was able to maintain intraoperative hemodynamic parameters better(P<0.05),and the visual analogue scale(VAS)scores of the observation group were significantly lower than those of the control group at 3 h,6 h,9 h,and 12 h postoperatively;the difference of interaction between groups,time points and time points between groups were statistically significant(P<0.05).Although the postoperative leukocyte values were comparable,the postoperative levels of inflammatory factors and glycocalyx injury markers were different between the two groups.The levels of IL-1,IL-6,IL-8,TNF-α,CRP,procalcitonin,and glycocalyx injury markers in the observation group were significantly lower than those in the control group(P<0.05).In addition,the incidence of postoperative adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion In patients undergoing laparoscopic cholecystectomy for cholecystolithiasis with acute cholecystitis,the administration of dexmedetomidine before induction of general anesthesia can better maintain intraoperative hemodynamic parameters,effectively improve postoperative pain,and reduce the occurrence of postoperative inflammation and adverse reactions.In addition,it can inhibit the shedding of vascular endothelial glycocalyx and improve the immune function of the body,and thus promote the recovery of patients after surgery.