右美托咪定对胃癌根治术患者应激反应、炎症因子水平的影响
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摘要
目的探究右美托咪定对胃癌根治术患者应激反应、炎症因子水平的影响。方法选取2015年5月至2017年3月我院收治的胃癌根治术患者96例,依据入院时间分为对照组(n=48)和观察组(n=48),对照组于麻醉诱导前予以生理盐水,观察组于麻醉诱导前予以右美托咪定。于注入生理盐水或右美托咪定前及术后,对患者血液样本进行采集,分析其应激指标、炎症因子及临床症状的变化。结果术后两组皮质醇(Cor)、肾上腺素(E)及促肾上腺皮质激素(ACTH)较术前均明显增加(P<0.05),且对照组Cor、E及ACTH较观察组增加更为显著(P<0.05);两组CD4+及CD4+/CD8+较术前明显下降(P<0.05),而超敏C反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)较术前显著上升(P<0.05);且对照组CD4+、CD4+/CD8+下降程度与hs-CRP、TNF-α上升程度显著高于观察组(P<0.05);观察组视觉模拟疼痛评分(VAS)较对照组显著降低(P<0.05),且其不良反应发生率显著低于对照组(12.50%vs 39.58%,P<0.05)。结论右美托咪定辅助麻醉治疗可有效改善胃癌根治术患者应激反应、炎症因子水平,降低术后疼痛度与不良反应发生率。
Objective To investigate the effects of dexmedetomidine on stress and inflammatory factors in patients undergoing radical gastrectomy for gastric cancer.Methods From May,2015 to March,2017,96 patients underwent radical gastrectomy for gastric cancer in our hospital.According to the admission time,the patients were divided into control group(n=48) and observation group(n=48) and were given normal saline and dexmedetomidine before anesthesia induction,respectively.Blood samples were collected before and after the injection of normal saline and dexmedetomidine for analysis of stress indexes and immune and inflammatory factors;postoperative pain and adverse events were recorded and compared between the 2groups.Results In both groups,blood levels of cortisol,epinephrine and adrenocorticotropic hormone(ACTH) were increased significantly after the operation(P<0.05),and such increments were more significant in the control group(P<0.05).The count of CD4+T lymphocytes and the ratio CD4+/CD8+were significantly lowered(P<0.05) while high-sensitivity C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α) were increased significantly in both groups after the operation(P<0.05),and these variations were more obvious in the control group(P<0.05).Compared with those in the control group,the patients in the observation group had significantly lower Visual Analog Scale scores(P<0.05) and also significantly lower incidences of postoperative adverse events(12.50% vs 39.58%,P<0.05).Conclusion Dexmedetomidine-assisted anesthesia can effectively improve stress response and immune inflammatory state and reduce postoperative pain and adverse reactions in patients undergoing radical gastrectomy for gastric cancer.
Objective To investigate the effects of dexmedetomidine on stress and inflammatory factors in patients undergoing radical gastrectomy for gastric cancer.Methods From May,2015 to March,2017,96 patients underwent radical gastrectomy for gastric cancer in our hospital.According to the admission time,the patients were divided into control group(n=48) and observation group(n=48) and were given normal saline and dexmedetomidine before anesthesia induction,respectively.Blood samples were collected before and after the injection of normal saline and dexmedetomidine for analysis of stress indexes and immune and inflammatory factors;postoperative pain and adverse events were recorded and compared between the 2groups.Results In both groups,blood levels of cortisol,epinephrine and adrenocorticotropic hormone(ACTH) were increased significantly after the operation(P<0.05),and such increments were more significant in the control group(P<0.05).The count of CD4+T lymphocytes and the ratio CD4+/CD8+were significantly lowered(P<0.05) while high-sensitivity C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α) were increased significantly in both groups after the operation(P<0.05),and these variations were more obvious in the control group(P<0.05).Compared with those in the control group,the patients in the observation group had significantly lower Visual Analog Scale scores(P<0.05) and also significantly lower incidences of postoperative adverse events(12.50% vs 39.58%,P<0.05).Conclusion Dexmedetomidine-assisted anesthesia can effectively improve stress response and immune inflammatory state and reduce postoperative pain and adverse reactions in patients undergoing radical gastrectomy for gastric cancer.
引文
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[7]宋强,宋海霞,边洪春,等.全麻剖宫产患者术前泵注右美托咪定对其应激反应和血流波动的影响[J].中国妇幼健康研究,2017,28(9):1154-1156.DOI:10.3969/j.issn.1673-5293.2017.09.038.SONG Q,SONG H X,BIAN H C,et al.Effects of preoperative dexmedetomidine on stress response and blood flow fluctuation in patients undergoing general anesthesia cesarean section[J].Chin J Woman Child Health Res,2017,28(09):1154-1156.DOI:10.3969/j.issn.1673-5293.2017.09.038.
[8]赵伟新,宋慧钢,李保林,等.不同麻醉方式对急腹症感染性休克患者影响研究[J].中华医院感染学杂志,2016,26(5):1078-1080.DOI:10.11816/cn.ni.2016-152788.ZHAO W X,SONG H G,LI B L,et al.Study on the effect of different anesthesia methods on patients with acute abdomen septic shock[J].Chin J Nosocomiol,2016,26(5):1078-1080.DOI:10.11816/cn.ni.2016-152788.
[9]俞晨,贾东林,张小青,等.右美托咪定对宫腹腔镜手术患者镇痛疗效与安全性的研究[J].中国临床药理学杂志,2015,21(2):89-92.DOI:10.13699/j.cnki.1001-6821.2015.02.003.YU C,JIA D L,ZHANG X Q,et al.Study on the efficacy and safety of dexmedetomidine for analgesia in patients undergoing laparoscopic surgery[J].Chin J Clin Pharmacol,2015,21(2):89-92.DOI:10.13699/j.cnki.1001-6821.2015.02.003.
[10]王仲,许卫东,滕步伟.微创手术与开腹手术治疗重症胰腺炎的围术期应激反应及术后炎性反应[J].实用医学杂志,2016,32(12):1997-1998.DOI:10.3969/j.issn.1006-5725.2016.12.031.WANG Z,XU W D,TENG B W.Perioperative stress response and postoperative inflammatory response in patients with severe pancreatitis treated by minimally invasive surgery and open surgery[J].J Pract Med,2016,32(12):1997-1998.DOI:10.3969/j.issn.1006-5725.2016.12.031.
[11]刘国奕.右美托咪定对老年胃癌根治术患者T细胞亚群及自然杀伤细胞的影响[J].中国老年学杂志,2015,35(8):2057-2059.DOI:10.3969/j.issn.1005-9202.2015.08.021.LIU G Y.Effects of dexmedetomidine on T cell subsets and natural killer cells in elderly patients undergoing radical gastrectomy[J].Chin J of Gerontol,2015,35(8):2057-2059.DOI:10.3969/J.issn.1005-9202.2015.08.021.
[12]徐勇民,傅艳师,郑艳萍,等.右美托咪定对七氟烷全麻乳腺癌根治术围术期免疫功能的影响[J].实用医学杂志,2016,32(10):1681-1684.DOI:10.3969/j.issn.1006-5725.2016.10.039.XU Y M,FU Y S,ZHENG Y P,et al.Effects of dexmedetomidine on perioperative immune function in patients with sevoflurane general anesthesia for radical mastectomy[J].JPract Med,2016,32(10):1681-1684.DOI:10.3969/j.issn.1006-5725.2016.10.039.
[13]马燕,于湘友.不同剂量右美托咪定对脓毒症大鼠早期免疫调节的影响[J].中华急诊医学杂志,2016,25(9):1149-1153.DOI:10.3760/cma.j.issn.1671-0282.2016.09.011.MA Y,YU X Y.Effects of different doses of dexmedetomidine on early immune regulation in septic rats[J].Chin JEmerg Med,2016,25(9):1149-1153.DOI:10.3760/cma.j.issn.1671-0282.2016.09.011.
[14]郑永超,黄燕,姜虹.右美托咪定对老年高血压患者全麻诱导气管插管应激反应的影响[J].重庆医学,2016,45(9):1220-1222.DOI:10.3969/j.issn.1671-8348.2016.09.021.ZHENG Y C,HUANG Y,JIANG H.Effects of dexmedetomidine on general anesthesia-induced tracheal intubation stress response in elderly hypertensive patients[J].Chongqing Med,2016,45(9):1220-1222.DOI:10.3969/j.issn.1671-8348.2016.09.021.
[2]左婷婷,郑荣寿,曾红梅,等.中国胃癌流行病学现状[J].中国肿瘤临床,2017,44(1):52-58.DOI:10.3969/j.issn.1000-8179.2017.01.881.ZUO T T,ZHENG R S,ZENG H M,et al.Epidemiology of stomach cancer in China[J].Chin J Clin Oncol,2017,44(1):52-58.DOI:10.3969/j.issn.1000-8179.2017.01.881.
[3]闫永芳,冯新献,徐志霞,等.胃癌患者不同根治术后感染与创伤应激指标变化分析[J].中华医院感染学杂志,2016,26(17):4017-4019.DOI:10.11816/cn.ni.2016-160373.YAN Y F,FENG X X,XU Z X,et al.Changes in infection and traumatic stress index after different radical mastectomy in patients with gastric cancer[J].Chin J Nosocomiol,2016,26(17):4017-4019.DOI:10.11816/cn.ni.2016-160373.
[4]朱容艳,扬慧娟.不同麻醉药物对老年胃癌手术患者应激反应、炎性因子、免疫及认知功能的影响[J].中国老年学杂志,2018,38(13):3155-3158.DOI:10.3969/j.issn.1005-9202.2018.13.034.ZHU R Y,YANG H J.Effects of different anesthetics on stress response,inflammatory factors,immunity and cognitive function in elderly patients with gastric cancer[J].Chin JGerontol,2018,38(13):3155-3158.DOI:10.3969/j.issn.1005-9202.2018.13.034.
[5]SALEH J,EL-OTHMANI M M,SALEH K J.Deep vein thrombosis and pulmonary embolism considerations in orthopedic surgery[J].Orthop Clin North Am,2017,48(2):127-135.DOI:10.1016/j.ocl.2016.12.003.
[6]赵娟,郑丽宏.右美托咪定在临床麻醉中的作用优势[J].实用医学杂志,2015,31(8):1355-1357.DOI:10.3969/j.issn.1006-5725.2015.08.053.ZHAO J,ZHENG L H.The role of dexmedetomidine in clinical anesthesia[J].J Pract Med,2015,31(8):1355-1357.DOI:10.3969/j.issn.1006-5725.2015.08.053.
[7]宋强,宋海霞,边洪春,等.全麻剖宫产患者术前泵注右美托咪定对其应激反应和血流波动的影响[J].中国妇幼健康研究,2017,28(9):1154-1156.DOI:10.3969/j.issn.1673-5293.2017.09.038.SONG Q,SONG H X,BIAN H C,et al.Effects of preoperative dexmedetomidine on stress response and blood flow fluctuation in patients undergoing general anesthesia cesarean section[J].Chin J Woman Child Health Res,2017,28(09):1154-1156.DOI:10.3969/j.issn.1673-5293.2017.09.038.
[8]赵伟新,宋慧钢,李保林,等.不同麻醉方式对急腹症感染性休克患者影响研究[J].中华医院感染学杂志,2016,26(5):1078-1080.DOI:10.11816/cn.ni.2016-152788.ZHAO W X,SONG H G,LI B L,et al.Study on the effect of different anesthesia methods on patients with acute abdomen septic shock[J].Chin J Nosocomiol,2016,26(5):1078-1080.DOI:10.11816/cn.ni.2016-152788.
[9]俞晨,贾东林,张小青,等.右美托咪定对宫腹腔镜手术患者镇痛疗效与安全性的研究[J].中国临床药理学杂志,2015,21(2):89-92.DOI:10.13699/j.cnki.1001-6821.2015.02.003.YU C,JIA D L,ZHANG X Q,et al.Study on the efficacy and safety of dexmedetomidine for analgesia in patients undergoing laparoscopic surgery[J].Chin J Clin Pharmacol,2015,21(2):89-92.DOI:10.13699/j.cnki.1001-6821.2015.02.003.
[10]王仲,许卫东,滕步伟.微创手术与开腹手术治疗重症胰腺炎的围术期应激反应及术后炎性反应[J].实用医学杂志,2016,32(12):1997-1998.DOI:10.3969/j.issn.1006-5725.2016.12.031.WANG Z,XU W D,TENG B W.Perioperative stress response and postoperative inflammatory response in patients with severe pancreatitis treated by minimally invasive surgery and open surgery[J].J Pract Med,2016,32(12):1997-1998.DOI:10.3969/j.issn.1006-5725.2016.12.031.
[11]刘国奕.右美托咪定对老年胃癌根治术患者T细胞亚群及自然杀伤细胞的影响[J].中国老年学杂志,2015,35(8):2057-2059.DOI:10.3969/j.issn.1005-9202.2015.08.021.LIU G Y.Effects of dexmedetomidine on T cell subsets and natural killer cells in elderly patients undergoing radical gastrectomy[J].Chin J of Gerontol,2015,35(8):2057-2059.DOI:10.3969/J.issn.1005-9202.2015.08.021.
[12]徐勇民,傅艳师,郑艳萍,等.右美托咪定对七氟烷全麻乳腺癌根治术围术期免疫功能的影响[J].实用医学杂志,2016,32(10):1681-1684.DOI:10.3969/j.issn.1006-5725.2016.10.039.XU Y M,FU Y S,ZHENG Y P,et al.Effects of dexmedetomidine on perioperative immune function in patients with sevoflurane general anesthesia for radical mastectomy[J].JPract Med,2016,32(10):1681-1684.DOI:10.3969/j.issn.1006-5725.2016.10.039.
[13]马燕,于湘友.不同剂量右美托咪定对脓毒症大鼠早期免疫调节的影响[J].中华急诊医学杂志,2016,25(9):1149-1153.DOI:10.3760/cma.j.issn.1671-0282.2016.09.011.MA Y,YU X Y.Effects of different doses of dexmedetomidine on early immune regulation in septic rats[J].Chin JEmerg Med,2016,25(9):1149-1153.DOI:10.3760/cma.j.issn.1671-0282.2016.09.011.
[14]郑永超,黄燕,姜虹.右美托咪定对老年高血压患者全麻诱导气管插管应激反应的影响[J].重庆医学,2016,45(9):1220-1222.DOI:10.3969/j.issn.1671-8348.2016.09.021.ZHENG Y C,HUANG Y,JIANG H.Effects of dexmedetomidine on general anesthesia-induced tracheal intubation stress response in elderly hypertensive patients[J].Chongqing Med,2016,45(9):1220-1222.DOI:10.3969/j.issn.1671-8348.2016.09.021.