麻醉因素对急性肠梗阻患者肠道屏障功能的影响:右美托咪定复合麻醉  

Effect of anesthetic factor on intestinal barrier function in patients with acute intestinal obstruction:dexmedetomidine-based anesthesia

作　　者：郑羡河[1] 何锐[1] 丁倩男[2] 王玉龙[1] 李玉红[1,2] Zheng Xianhe;He Rui;Ding Qiannan;Wang Yulong;Li Yuhong(Department of Anesthesiology,Shaoxing People′s Hospital,Shaoxing 312000,China;Clinical Research Center,Shaoxing People′s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院麻醉科,312000 [2]绍兴市人民医院医学研究中心,312000

出　　处：《中华麻醉学杂志》2020年第4期395-398,共4页Chinese Journal of Anesthesiology

基　　金：浙江省科学技术厅公益项目(LGF19H030011);浙江省卫计委医药卫生科技计划(2018KY173);绍兴市麻醉学重点学科(2019SZD04)。

摘　　要：目的评价右美托咪定复合麻醉对急性肠梗阻患者肠道屏障功能的影响。方法选择胃肠外科及肛肠科住院手术治疗的急性肠梗阻患者94例,年龄33~81岁,体重48~80 kg,ASA分级Ⅰ或Ⅱ级。按随机数字表法将患者分为2组(n=47):常规麻醉组(R组)和右美托咪定复合麻醉组(D组)。D组在全麻诱导前静脉注射右美托咪定负荷剂量1μg/kg 15 min,随后以0.5μg·kg^-1·h^-1速率静脉输注至术毕前30 min。于右美托咪定负荷剂量输注前(T0)、术后1 d(T1)、术后3 d(T2)和术后7 d(T3)时抽取外周静脉血样,采用ELISA法检测血清二胺氧化酶(DAO)、D-乳酸(D-LAC)、细菌内毒素(BT)、TNF-α及IL-6浓度。记录术后并发症发生情况、肛门排气时间及住院时间。结果与R组比较,D组T1,2时血清DAO、D-LAC、BT、TNF-α及IL-6浓度降低,肛门排气时间及住院时间缩短,需呼吸循环支持发生率和并发症总发生率降低(P<0.05)。结论右美托咪定复合麻醉对急性肠梗阻患者肠道屏障功能有一定保护作用。Objective To evaluate the effect of dexmedetomidine-based anesthesia on intestinal barrier function in the patients with acute intestinal obstruction.Methods Ninety-four patients with acute intestinal barrier obstruction,aged 33-81 yr,weighing 48-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into 2 groups(n=47 each)using a random number table method:routine anesthesia group(group R)and dexmedetomidine-based anesthesia group(group D).In group D,dexmedetomidine was intravenously injected in a loading dose of 1μg/kg at 15 min before induction of general anesthesia followed by an infusion of 0.5μg·kg-1·h-1 until 30 min before the end of operation.Before infusing the loading dose of dexmedetomidine,at 1 day after surgery,at 3 days after surgery,and at 7 days after surgery,peripheral venous blood samples were collected to measure the concentrations of diamine oxidase,D-lactic acid,bacterial endotoxin,tumor necrosis factor-αand interleukin-6.The occurrence of postoperative complications,anal exhaust time and average length of hospital stay were recorded.Results Compared with group R,the concentrations of diamine oxidase,D-lactic acid,bacterial endotoxin,tumor necrosis factor-αand interleukin-6 were significantly decreased at 1 and 3 days after surgery,anal exhaust time and average length of hospital stay were shortened,and the requirement for respiratory cycle support and total incidence of complications were decreased in group D(P<0.05).Conclusion Dexmedetomidine-based anesthesia can improve intestinal barrier function to a certain extent in patients with acute intestinal obstruction.

关 键 词：右美托咪啶 肠梗阻 肠黏膜 

分 类 号：R614[医药卫生—麻醉学]