右美托咪定对直肠癌患者围术期血流动力学、免疫功能及应激反应的影响  

Effects of dexmedetomidine on perioperative hemodynamics,immune function and stress response in patients with rectal cancer

作　　者：苏鸿莉[1] 李玲霞[1] 白延斌[1] 刘艳玲 SU Hongli;LI Lingxia;BAI Yanbin;LIU Yanling(Department of Anesthesiology,Yan'an University Affiliated Hospital,Yan'an 716000,Shaanxi Province,China)

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000

出　　处：《世界临床药物》2022年第9期1154-1159,共6页World Clinical Drug

基　　金：陕西省科技厅科技攻关项目(2016SF-075);延安市科技局科攻关重点项目(SL2019ZCSZ-003);延安市科技局科技攻关项目(SL2019ZCSY-002)。

摘　　要：目的研究右美托咪定对直肠癌患者围手术期血流动力学、免疫功能及应激反应的影响。方法选取2016年1月至2019年2月在我院行直肠癌根治术的患者128例,分为观察组64例和对照组64例。观察组于麻醉诱导前30 min静脉泵入右美托咪定至手术结束,对照组给予等量的生理盐水,其余麻醉方法均与观察组相同。分别在麻醉诱导前(T1)、手术结束即刻(T2)、手术结束后30 min(T3)及手术结束后24 h(T4)记录两组心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、外周血氧饱和度(peripheral oxygen saturation,SpO)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+))以及自然杀伤细胞(natural killer cell,NK)。采用酶联免疫吸附法检测皮质醇(cortisol,CO)、血浆肾上腺素、去甲肾上腺素水平。结果与T1比较,观察组T2、T3的HR明显减慢,MAP明显降低;而对照组T2、T3的HR明显加快,MAP明显升高,研究组T2、T3时间点HR、MAP水平均低于对照组,差异具有统计学意义(P<0.013)。观察组T1~T4 HR变化幅度低于对照组(P<0.05)。与T1时间点比较,两组T2~T4时间点CD3^(+)、CD4^(+)及NK细胞水平均有降低(P<0.013),对照组T2~T4时间点CD4^(+)/CD8^(+)水平降低(P<0.013),观察组CD4^(+)/CD8^(+)在T2时间点升高,T3、T4时间点降低(P<0.013);观察组在T2~T4时CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及NK细胞水平高于对照组(P<0.013)。与T1时间点比较,对照组T2~T4时间点血糖、血浆肾上腺素以及去甲肾上腺素水平水平均升高(P<0.013)。观察组T2~T4时间点血糖、CO、血浆肾上腺素以及去甲肾上腺素水平均低于对照组(P<0.013)。结论右美托咪定可有效维持直肠癌患者围手术期血流动力学的稳定,改善机体细胞免疫功能,显著减少患者在围手术期的应激反应,促进术后恢复。Objective To investigate the effects of dexmedetomidine on hemodynamics,immune function and stress response in patients with rectal cancer during perioperative period.Methods A total of 128 patients with rectal cancer who underwent radical resection in our hospital from January 2016 to February 2019 were selected and divided into observation group(n=64)and control group(n=64).In the observation group,dexmedetomidine was pumped intravenously 30 minutes before anesthesia induction until the end of the operation.Patients in the control group were given the same amount of normal saline.Other anesthesia methods were the same as those in the observation group.Heart rate(HR),mean arterial pressure(MAP),peripheral oxygen saturation(SpO_(2)),T-lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+) and CD4^(+)/CD8^(+)) and natural killer(NK)cells were recorded before anesthesia induction(T1),immediately after surgery(T2),30 minutes after surgery(T3)and 24 hours after surgery(T4).The levels of cortisol(CO),plasma epinephrine and norepinephrine were measured by enzyme-linked immunosorbent assay.Results Compared with T1,HR at T2 and T3 in the observation group was significantly slowed down and MAP was significantly decreased.However,the HR at T2 and T3 in the control group was significantly accelerated,and the MAP was significantly increased,The levels of HR and MAP at T2 and T3 time points in the study group were lower than those in the control group,and the differences between the two groups were statistically significant(P<0.013).The change of HR at T1 to T4 in the observation group was lower than those in the control group(P<0.05).Compared with T1 time point,the levels of CD3^(+),CD4^(+) and NK cells at T2,T3 and T4 time points in the two groups decreased(P<0.013);The levels of CD4^(+)/CD8^(+) at T2,T3 and T4 time points in the control group decreased(P<0.013);CD4^(+)/CD8^(+) in the observation group increased at T2 time point,while T3 and T4 time points decreased(P<0.013);The levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+) and NK

关 键 词：右美托咪定 直肠癌 血流动力学 免疫功能 应激反应 

分 类 号：R614.3[医药卫生—麻醉学]