右美托咪定对妇科腔镜手术CO_(2)气腹肠损伤的影响  

Effect of dexmedetomidine on CO_(2)pneumoperitoneum injury in gynecological laparoscopic surgery

作　　者：马欢[1] 高东艳[2] 樊心钰 刘伟[1] 张利[1] MA Huan;GAO Dongyan;FAN Xinyu;LIU Wei;ZHANG Li(Department of Anesthesiology,Shanxi Medical University,Shanxi Taiyuan 030001,China;Department of Anesthesiology,Second Affiliated Hospital of Shanxi Medical University,Shanxi Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第二医院麻醉科,山西太原030001

出　　处：《现代肿瘤医学》2022年第18期3381-3384,共4页Journal of Modern Oncology

摘　　要：目的:探讨右美托咪定(DEX)对妇科腹腔镜手术CO_(2)气腹过程中肠损伤的影响。方法:选取拟在全麻下行腹腔镜下子宫肌瘤剔除术的多发子宫肌瘤患者40例,按随机数字表法分为实验组和对照组,每组各20例,对照组常规行静脉麻醉诱导和维持;实验组常规麻醉诱导前给予DEX负荷剂量0.5μg/kg(10 min内输注完毕),常规行静脉麻醉诱导,DEX改为维持剂量0.2μg/(kg·h)直至手术结束,在麻醉诱导前10 min(T_(1)),气腹解除后1 h(T_(2)),气腹解除后24 h(T_(3))分别取两组患者的静脉血,测定血清中紧密连接蛋白claudin-1和二胺氧化酶(DAO)含量,观察比较两组患者claudin-1和DAO的变化规律以及使用DEX预处理后对claudin-1和DAO表达的影响。结果:对照组患者血清claudin-1含量T_(2)、T_(3)时刻低于T_(1)时刻,差异具有统计学意义(P<0.001),DAO含量T_(2)、T_(3)时刻均大于T_(1)时刻,差异具有统计学意义(P<0.001);实验组患者claudin-1和DAO含量在不同时间点比较差异无统计学意义,实验组患者claudin-1蛋白含量在T_(2)、T_(3)时刻均高于对照组患者T_(2)、T_(3)时刻蛋白含量(P<0.05,P<0.01),实验组患者DAO含量在T_(2)、T_(3)时刻均低于对照组患者T_(2)、T_(3)时刻DAO含量(P<0.001,P<0.05)。结论:妇科腔镜手术CO_(2)气腹会造成一定的肠损伤;DEX预处理后,通过上调肠上皮细胞claudin-1蛋白表达,增强肠上皮细胞屏障功能,使释放入血的DAO含量减少,说明DEX干预对CO_(2)气腹造成的肠损伤具有一定的防治作用。Objective:To investigate the effect of dexmedetomidine(DEX)on intestinal injury during CO_(2)pneumoperitoneum in gynecological laparoscopic surgery.Methods:40 patients with multiple myoma of uterus undergoing laparoscopic myomectomy under general anesthesia were randomly divided into two groups,including experimental group(n=20)and control group(n=20).The control group received intravenous anesthesia induction and maintenance.In the experimental group,DEX was given a loading dose of 0.5μg/kg before induction of general anesthesia(10 min after infusion),and intravenous anesthesia was given routinely.DEX was maintained at 0.2μg/(kg·h)until the end of operation.DEX was given 10 min before induction of general anesthesia(T_(1))and one hour after ventilation(T_(2)),the levels of tight junction protein claudin-1 and diamine oxidase(DAO)in serum were measured at 24 h(T_(3))after ventilation,the changes of claudin-1 and DAO were observed and compared between the two groups,and the effects of pretreatment with DEX on the expression of claudin-1 and DAO.Results:The serum claudin-1 levels in the control group were significantly lower at T_(2)and T_(3)than at T_(1)(P<0.001),and the levels of DAO were significantly higher at T_(2)and T_(3)than at T_(1)(P<0.001).The content of claudin-1 and DAO in the experimental group had no significant difference at different time points.The content of claudin-1 protein in the experimental group was higher than that in the control group at T_(2)and T_(3)(P<0.05,P<0.01),the content of DAO in experimental group was lower than that in control group at T_(2)and T_(3)(P<0.001,P<0.05).Conclusion:CO_(2)pneumoperitoneum can cause intestinal injury in gynecologic laparoscopic surgery,and after DEX pretreatment,the intestinal epithelial cell barrier function was enhanced by up-regulating claudin-1 protein expression,and the content of DAO released into the blood was decreased,the results showed that DEX intervention could prevent and cure intestinal injury caused by CO_(2)pneumoperitoneum.

关 键 词：右美托咪定 妇科腹腔镜手术 CO_(2)气腹 肠损伤 紧密连接蛋白 CLAUDIN-1 

分 类 号：R737.33[医药卫生—肿瘤]