右美托咪定术中应用对直肠癌腹腔镜切除术患者免疫功能及应激反应的影响  

Effect of Dexmedetomidine on Immune Function and Stress Response in Laparoscopic Resection of Rectal Cancer

作　　者：刘智[1] 何慧鑫[1] 滕永杰[1] LIU Zhi;HE Hui-xin;TENG Yong-jie(Department of Anesthesiology,the First Affiliated Hospital of Hunan University of traditional Chinese medicine,Changsha 410007,Hunan)

机构地区：[1]湖南中医药大学第一附属医院麻醉科,湖南长沙410007

出　　处：《医学临床研究》2020年第4期513-515,518,共4页Journal of Clinical Research

基　　金：湖南卫健委项目(B20180623)。

摘　　要：[目的]探讨右美托咪定术中应用对直肠癌腹腔镜切除患者免疫功能及应激反应的影响.[方法]选取2017年5月至2018年5月本院收治的88例择期行直肠癌腹腔镜手术的患者,根据随机数表法将其分为观察组和对照组,每组各44例.观察组于麻醉诱导前0.5 h泵注右美托咪定,负荷剂量为0.5μg/kg,之后维持剂量0.3μg/(kg·h)输注直至手术结束,对照组给予等负荷剂量、等维持剂量生理盐水,比较两组麻醉诱导前(T0)、术毕即刻(T1)、术后24 h(T2)、术后72 h(T3)时段的T淋巴细胞亚群、去甲肾上腺素(NE)、肾上腺素(E)水平,记录两组T0、插管即刻(Ta)、T1、拔管即刻(Tb)时心率(HR)、平均动脉压(MAP)变化.[结果]两组各时段CD8^+水平相比均无明显差异(P>0.05),两组T1~T3时段CD3^+、CD4^+、CD4^+/CD8^+与T0时比较差异有统计学意义,且观察组T1~T3时段CD3^+、CD4^+、CD4^+/CD8^+水平均高于对照组(P<0.05).两组T1~T3时段NE、E水平与T0比较有统计学差异,且观察组T1~T3时段NE、E水平明显低于对照组(P<0.05).对照组Ta、T1、Tb时段HR、MAP与T0时相比有显著差异,且观察组Ta、T1、Tb时段HR、MAP与对照组比,差异有统计学意义(P<0.05).[结论]直肠癌患者行腹腔镜手术时泵注右美托咪定可改善机体免疫功能,减轻围术期应激反应,值得临床借鉴应用.[Objective]To investigate the effect of dexmedetomidine on immune function and stress response in patients with rectal cancer undergoing laparoscopic resection.[Methods]From May 2017 to may 2018,88 patients with rectal cancer undergoing laparoscopic surgery were selected and divided into observation group and control group according to the random number table method,44 cases in each group.In the observation group,dexme-detomidine was pumped 0.5 hours before anesthesia induction,the loading dose was 0.5μg/kg,and then main-tained 0.3μg/(kg·h)until the end of the operation.In the control group,the same loading dose and the same maintenance dose of normal saline were given.The two groups were compared before anesthesia induction(T0),immediately after operation(T1),24 hours after operation(T2),and T lymphocyte subsets 72 hours after operation(T3),noradrenaline(NE)and adrenaline(E)levels.The changes of heart rate(HR)and mean arterial pressure(MAP)in T0,Ta,T1 and Tb were recorded.[Results]There was no significant difference in CD8^+level between the two groups(P>0.05).There was significant difference in CD3^+,CD4^+,CD4^+/CD8^+ between T1-T3 and T0 in the two groups,and the levels of CD3^+,CD4^+,CD4^+/CD8^+in the observation group were higher than those in the control group(P<0.05).There was significant difference between the NE and E levels of T1-T3 and T0,and the levels of NE and E in T1-T3 stage in the observation group were significantly lower than those in the control group(P<0.05).The HR and MAP of T0,T1 and Tb in the control group were significantly different from those in T0,and the HR and MAP of T0,T1 and Tb in the observation group were significantly different from those in the control group(P<0.05).[Conclusion]The pump of dexmedetomidine in patients with rectal cancer during laparoscopic surgery can improve the immune function and alleviate the perioperative stress response,which is worthy of clinical reference.

关 键 词：直肠肿瘤/外科学 腹腔镜检查 右美托咪定/药理学 免疫测定 

分 类 号：R735.37[医药卫生—肿瘤]