右美托咪定对硬膜外麻醉胃癌根治术患者围手术期外周血T淋巴细胞亚群的影响
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摘要
目的探讨右美托咪定对硬膜外麻醉胃癌根治术患者围手术期外周血T淋巴细胞亚群的影响。方法选取2016年3月至2017年4月间在辽宁省营口市中心医院行硬膜外麻醉胃癌根治术的86例患者,采用数表法随机分为对照组和观察组,每组43例。两组患者皆采用相同的入室麻醉、静脉穿刺、麻醉诱导及维持方法,对照组患者麻醉诱导前静脉泵入生理盐水,观察组患者相同阶段泵入右美托咪定。检测麻醉诱导前、麻醉后5min、术中1h、术毕、术后1d和术后3d时外周血T淋巴细胞亚群的水平,比较两组患者的血清白细胞介素-6(IL-6)和血浆皮质醇(Cor)浓度,统计并比较两组患者的苏醒时间、拔管时间和不良反应发生率。结果麻醉诱导前、麻醉后5min和术中1h时,两组患者的IL-6浓度比较,差异无统计学意义(P> 0. 05);术中1h、术毕和术后1d时,观察组患者血清IL-6浓度低于对照组患者,差异均有统计学意义(均P <0. 05)。麻醉诱导前、麻醉后5min、术后1d和术后3d时,两组患者的血浆Cor浓度比较,差异无统计学意义(P> 0. 05)。术中1h和术毕时,观察组血浆Cor浓度低于对照组,差异均有统计学意义(均P <0. 05)。麻醉诱导前时,两组患者外周血T淋巴细胞亚群水平比较,差异无统计学意义(P> 0. 05)。麻醉后5min、术中1h、术毕、术后1d和术后3d时,观察组患者CD+3、CD+4、CD+8和CD+4/CD+8水平高于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者苏醒时间和拔管时间短于对照组患者,差异均有统计学意义(均P <0. 05)。观察组不良反应发生率18. 6%低于对照组的39. 5%,差异有统计学意义(P <0. 05)。结论右美托咪定可以有效抑制硬膜外麻醉胃癌根治术患者围手术期应激反应,并提高患者外周血T淋巴细胞亚群水平。
Objective To observe the effects of dexmedetomidine on perioperative T lymphocyte subsets in peripheral blood in patients undergoing radical resection for gastric cancer under epidural anesthesia. Methods A total of 86 patients who underwent radical resection for gastric cancer under epidural anesthesia at Yingkou Central Hospital from March 2016 to April 2017 were selected. They were divided into an observation group and a control group according to the random number table method,with 43 patients in each group. The two groups were given the same anesthesia,venipuncture,anesthesia induction and maintenance method,and the observation group was pumped with dexmedetomidine before anesthesia induction and the control group was intravenously pumped with saline at the same stage. The levels of T lymphocyte subsets in peripheral blood were measured before anesthesia induction,at 5 min after anesthesia,intraoperative 1 h,at the end of surgery,1 d after surgery and 3 d after surgery. Serum interleukin-6( IL-6) and plasma cortisol( Cor),the recovery time,extubation time and incidence of adverse reactions were compared between the two groups. Results There was no significant difference in IL-6 between the two groups before anesthesia induction,at 5 min after anesthesia,and intraoperative 1 h( P > 0. 05). At the end of surgery and 1 d after surgery,IL-6 level was lower in the observation group than in the control group( all P <0. 05). There was no significant difference in Cor between the two groups before anesthesia induction,at5 min after anesthesia,1 d after surgery and 3 d after surgery( P > 0. 05). At intraoperative 1 h and at the end of surgery,plasma Cor concentration was lower in observation group than in control group( all P <0. 05). Before anesthesia induction,there was no significant difference in the levels of T lymphocyte subsets in peripheral blood between the two groups( P > 0. 05). At 5 min after anesthesia,intraoperative 1 h,at the end of surgery,1 d after surgery and 3 d after surgery,levels of CD+3,CD+4,CD+8 and CD+4/CD8+were higher in observation group than in the control group( all P < 0. 05). The recovery time and extubation time were less in observation group than in the control group( all P < 0. 05). The incidence of adverse reactions was 18. 6% which was lower in the observation group than that in the control group( P <0. 05). Conclusion Dexmedetomidine can effectively inhibit the perioperative stress response and improve the T lymphocyte subsets levels in peripheral blood in patients undergoing radical resection for gastric cancer under epidural anesthesia.
Objective To observe the effects of dexmedetomidine on perioperative T lymphocyte subsets in peripheral blood in patients undergoing radical resection for gastric cancer under epidural anesthesia. Methods A total of 86 patients who underwent radical resection for gastric cancer under epidural anesthesia at Yingkou Central Hospital from March 2016 to April 2017 were selected. They were divided into an observation group and a control group according to the random number table method,with 43 patients in each group. The two groups were given the same anesthesia,venipuncture,anesthesia induction and maintenance method,and the observation group was pumped with dexmedetomidine before anesthesia induction and the control group was intravenously pumped with saline at the same stage. The levels of T lymphocyte subsets in peripheral blood were measured before anesthesia induction,at 5 min after anesthesia,intraoperative 1 h,at the end of surgery,1 d after surgery and 3 d after surgery. Serum interleukin-6( IL-6) and plasma cortisol( Cor),the recovery time,extubation time and incidence of adverse reactions were compared between the two groups. Results There was no significant difference in IL-6 between the two groups before anesthesia induction,at 5 min after anesthesia,and intraoperative 1 h( P > 0. 05). At the end of surgery and 1 d after surgery,IL-6 level was lower in the observation group than in the control group( all P <0. 05). There was no significant difference in Cor between the two groups before anesthesia induction,at5 min after anesthesia,1 d after surgery and 3 d after surgery( P > 0. 05). At intraoperative 1 h and at the end of surgery,plasma Cor concentration was lower in observation group than in control group( all P <0. 05). Before anesthesia induction,there was no significant difference in the levels of T lymphocyte subsets in peripheral blood between the two groups( P > 0. 05). At 5 min after anesthesia,intraoperative 1 h,at the end of surgery,1 d after surgery and 3 d after surgery,levels of CD+3,CD+4,CD+8 and CD+4/CD8+were higher in observation group than in the control group( all P < 0. 05). The recovery time and extubation time were less in observation group than in the control group( all P < 0. 05). The incidence of adverse reactions was 18. 6% which was lower in the observation group than that in the control group( P <0. 05). Conclusion Dexmedetomidine can effectively inhibit the perioperative stress response and improve the T lymphocyte subsets levels in peripheral blood in patients undergoing radical resection for gastric cancer under epidural anesthesia.
引文
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[9]童博,杨宗林,张玉勤,等.右美托咪定对食管癌根治术患者外周血T淋巴细胞亚群、血循环微转移的影响[J].医学临床研究,2017,34(6):1169-1171.
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[3]刘书伟.右美托咪定对神经外科手术患者全身麻醉后苏醒期躁动的相关影响[J].国际医药卫生导报,2015,21(8):1111-1113.
[4]王南.全身麻醉复合硬膜外麻醉对胃癌根治术患者苏醒期躁动、免疫功能及认知功能障碍的影响[J].现代中西医结合杂志,2017,26(29):3272-3275.
[5]仲勇,袁岚,周嘉.不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果[J].临床和实验医学杂志,2016,15(24):2423-2425.
[6]张燕,郑利民.右美托咪啶的药理作用及临床应用进展[J].贵州医药,2016,28(5):544-547.
[7]丁春侠,孙烁.全麻复合硬膜外麻醉对胃癌根治术病人术后应激反应、炎症因子表达的影响[J].中国医疗设备,2017,32(s2):78-795.
[8]王梅芳,濮健峰,任建刚,等.右美托咪定或丙泊酚全麻复合硬膜外麻醉对胃癌根治术老年患者免疫功能的影响[J].临床麻醉学杂志,2016,32(11):1094-1096.
[9]童博,杨宗林,张玉勤,等.右美托咪定对食管癌根治术患者外周血T淋巴细胞亚群、血循环微转移的影响[J].医学临床研究,2017,34(6):1169-1171.