右美托咪定联合硬膜外麻醉对盆底重建术患者T细胞淋巴亚群、应激因子的影响  

Effects of Dexmedetomidine Combined with Epidural Anesthesia on T Cell Lymphocyte Subsets and Stress Factors in Patients Undergoing Pelvic Floor Reconstruction

作　　者：周勇[1] 刘喆[1] 刘远征 ZHOU Yong;LIU Zhe;LIU Yuanzheng(Department of Anesthesiology,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院麻醉科,河南南阳473000

出　　处：《河南医学研究》2024年第19期3559-3563,共5页Henan Medical Research

摘　　要：目的探讨右美托咪定联合硬膜外麻醉对盆底重建术患者T细胞淋巴亚群、应激因子的影响。方法回顾性分析2018年9月至2023年9月在南阳市中心医院接受盆底重建术患者的临床资料,将其中符合纳入标准的120例患者纳入研究,按不同麻醉方案分为对照组(60例)、观察组(60例)。对照组接受硬膜外麻醉,观察组接受右美托咪定联合硬膜外麻醉。以麻醉前(T_(0))、右美托咪定给药后(T_(1))、手术开始时(T_(2))、手术开始30 min(T_(3))、术毕时(T_(4))为时间节点,比较两组生命体征指标水平。以术后2、6、12、24、48 h为时间节点,比较两组疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分。以麻醉前、术后1 d为时间节点,比较两组T细胞淋巴亚群(CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+))、应激因子指标[血清皮质醇(Cor)、肾上腺素(NE)]水平。比较两组围手术期不良反应发生情况。结果观察组T_(1)、T_(2)、T_(3)、T_(4)时心率、平均动脉压水平均低于对照组(P<0.05)。观察组2、6、12 h的VAS评分低于对照组(P<0.05)。观察组不同时间段Ramsay镇静评分均高于对照组(P<0.05)。观察组术后1 d的CD3^(+)、CD4^(+)/CD8^(+)水平均高于对照组,CD8^(+)水平均低于对照组(P<0.05)。观察组术后1 d的Cor、NE水平均低于对照组(P<0.05);观察组不良反应总发生率与对照组差异无统计学意义(P>0.05)。结论右美托咪定联合硬膜外麻醉镇痛、镇静效果确切,能有效减轻HR、MAP水平波动,改善机体免疫状态、应激状态,且安全性有保障。Objective To investigate the effects of dexmedetomidine combined with epidural anesthesia on T cell lymphocyte subsets and stress factors in patients undergoing pelvic floor reconstruction.Methods Clinical data of patients undergoing pelvic floor reconstruction in Nanyang Central Hospital from September 2018 to September 2023 were retrospectively analyzed.There were 120 patients who met the inclusion criteria were included in the study and divided into control group(60 cases)and observation group(60 cases)according to different anesthesia protocols.The control group received epidural anesthesia,and the observation group received dexmedetomidine combined epidural anesthesia.Before anesthesia(T_(0)),after dexmedetomidine administration(T_(1)),at the beginning of surgery(T_(2)),30 min at the beginning of surgery(T_(3)),and at the end of surgery(T_(4))were used as time nodes to compare the level of vital signs of the two groups.Pain visual analogue scale(VAS)score and Ramsay sedation score were compared between the two groups at 2,6,12,24 and 48 h after surgery.The levels of T cell lymphocyte subsets(CD3^(+),CD8^(+),CD4^(+)/CD8^(+))and stress factors[serum cortisol(Cor),adrenaline(NE)]in the two groups were compared before and 1 day after anesthesia.The occurrence of adverse reactions during perioperative period was compared between the two groups.Results The heart rate and mean arterial pressure at T_(1),T_(2),T_(3) and T_(4) in observation group were lower than those in control group(P<0.05).VAS scores of observation group at 2,6 and 12 h were lower than those of control group(P<0.05).Ramsay sedation score in observation group was higher than that in control group at different time(P<0.05).The levels of CD3^(+)and CD4^(+)/CD8^(+)in observation group were higher than those in control group 1 day after surgery,and the levels of CD8^(+)were lower than those in control group(P<0.05).The levels of Cor and NE in observation group were lower than those in control group 1 day after surgery(P<0.05).The total incidence of ad

关 键 词：右美托咪定 硬膜外麻醉 盆底重建术 T细胞淋巴亚群 应激因子 

分 类 号：R713[医药卫生—妇产科学]