右美托咪定与丙泊酚对肝脏肿块切除术患儿血流动力学、应激反应和免疫功能影响的对比研究  

Comparative Study of the Effects of Dexmedetomidine and Propofol on Hemodynamics, Stress Response and Immune Function in Children Undergoing Liver Mass Resection

作　　者：韩笑 李正民 闫辉 王学佳 张进 虎崇康 HAN Xiao;LI Zheng-min;YAN Hui;WANG Xue-jia;ZHANG Jin;HU Chong-kang(Department of Anesthesiology,Tangdu Hospital of Air Force Medical University,Xi'an,Shanxi,710000,China;Department of Pediatrics,Tangdu Hospital of Air Force Medical University,Xi'an,Shaanxi,710000,China)

机构地区：[1]空军军医大学唐都医院麻醉科,陕西西安710000 [2]空军军医大学唐都医院儿科,陕西西安710000

出　　处：《现代生物医学进展》2024年第13期2463-2466,2433,共5页Progress in Modern Biomedicine

基　　金：陕西省重点研发计划项目(2022SF-189)。

摘　　要：目的:对比右美托咪定与丙泊酚对肝脏肿块切除术患儿血流动力学、应激反应和免疫功能影响。方法:采用随机数字表法将2021年5月~2023年4月期间我院收治的择期行肝脏肿块切除术患儿90例分为右美托咪定组(采用右美托咪定麻醉)、丙泊酚组(采用丙泊酚麻醉),各为45例。比较两组血流动力学[心率(HR)、平均动脉压(MAP)]、应激反应[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]、T淋巴细胞亚群[CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)]变化情况,并观察两组麻醉期间不良反应发生情况。结果:右美托咪定组麻醉诱导后10 min(T1)~手术结束时(T4)时间点MAP低于丙泊酚组,HR高于丙泊酚组(P<0.05)。右美托咪定组T4、术后1 d(T5)时间点Cor、ACTH低于丙泊酚组(P<0.05)。右美托咪定组T4、T5时间点CD8^(+)低于丙泊酚组,CD4^(+)、CD4^(+)/CD8^(+)高于丙泊酚组(P<0.05)。两组不良反应发生率组间对比未见差异(P>0.05)。结论:与丙泊酚麻醉相比,右美托咪定可更好地稳定肝脏肿块切除术患儿血流动力学,减轻应激反应,同时还可减轻免疫抑制。Objective: To compare the effects of dexmedetomidine and propofol on hemodynamics, stress response and immune function in children undergoing liver mass resection. Methods: The random number table method was used, 90 children who underwent elective liver mass resection in our hospital from May 2021 to April 2023 were divided into dexmedetomidine group(dexmedetomidine anesthesia) and propofol group(propofol anesthesia), 45 cases in each group. The changes of hemodynamics [heart rate(HR), mean arterial pressure(MAP)], stress response [cortisol(Cor), adrenocorticotropic hormone(ACTH)] and T lymphocyte subsets [CD4^(+), CD8^(+),CD4^(+)/CD8^(+)] were compared between two groups, and the incidence of adverse reactions during anesthesia was observed. Results: MAP in dexmedetomidine group was lower than that in propofol group at 10 min after anesthesia induction(T1) to the end of operation(T4),and HR was higher than that in propofol group(P<0.05). Cor and ACTH in dexmedetomidine group were lower than those in propofol group at T4 and 1 day after operation(T5)(P<0.05). CD8^(+) in dexmedetomidine group was lower than that in propofol group at T4 and T5, while CD4^(+) and CD4^(+)/CD8^(+) were higher than those in propofol group(P<0.05). There was no difference in the incidence of adverse reactions between two groups(P>0.05). Conclusion: Compare with propofol anesthesia, dexmedetomidine can better stabilize hemodynamics, reduce stress response, and reduce immunosuppression in children undergoing liver mass resection.

关 键 词：右美托咪定 丙泊酚 肝脏肿块 肝脏手术 血流动力学 应激反应 免疫功能 

分 类 号：R735.7[医药卫生—肿瘤]