右美托咪定辅助麻醉对宫颈癌根治术患者肠道功能的影响
|
摘要
目的:探讨右美托咪定对宫颈癌根治术患者肠道功能的影响。方法:选取2016年10月至2018年6月就诊于宜宾市第一人民医院择期行宫颈癌根治术患者92例为研究对象,根据随机数字表法将其分为对照组和观察组,各46例。观察组麻醉诱导前10 min予以0.5μg/kg右美托咪定稀释后在10 min泵完,随后以0.4μg/(kg·h)持续泵注至术毕前40 min;对照组以同样方法予以等容量生理盐水。两组镇痛均使用丙泊酚和瑞芬太尼。于给药前(T1)、手术结束时(T2)、手术后2 h(T3)和术后24 h(T4)对炎性因子(IL-6、TNF-α)及肠道通透性指标(DAO、D-LAC)进行监测。并比较两组住院时间及肠道功能恢复情况。结果:在T2、T3、T4时,观察组血清IL-6、TNF-α水平低于对照组(P <0. 05);在T2、T3、T4时,观察组血清DAO、D-LAC水平低于对照组(P <0. 05);观察组术后肠鸣音恢复时间、术后首次排便时间及总住院时间均短于对照组(P<0. 05)。结论:右美托咪定可减轻宫颈癌根治术患者炎性反应和肠黏膜损伤,促进肠道功能更快恢复。
Objective:To explore the effects of dexmedetomidine on intestinal function in patients with radical operation of cervical carcinoma.Methods:92 patients with radical operation of cervical carcinoma of the First People's Hospital in Yibin from October 2016 to June 2018 were selected as the subjects.According to the random digital table method,92 patients were divided into observation group and control group,and 46 cases in each group.The observation group was intravenously infused with 0.5 μg/kg dexmedetomidine for 10 minutes before the induction of anesthesia,then pumped continuously with 0.4 μg/(kg·h) until 40 minutes before operation.The control group was given intravenously with the equal volume of normal saline.The two groups were given with propofol and remifentanil analgesia.The inflammatory factors(IL-6,TNF-α) and indicators of intestinal permeability(DAO and D-LAC) were monitored before the administration(T1),at the end of operation(T2),2 h after operation(T3) and 24 h after operation(T4).The hospitalization time and bowel function recovery were compared between the two groups.Results:At T2,T3 and T4,serum IL-6,TNF-α levels in observation group were lower than those in control group(P<0.05).At T2,T3 and T4,serum DAO and D-LAC levels in observation group were lower than those in control group(P<0.05).The recovery time of bowel sounds,first defecation time and total hospitalization time of the observation group were shorter than those of the control group(P<0.05).Conclusion:Dexmedetomidine can alleviate inflammatory reaction and intestinal mucosal injury in patients undergoing radical cervical cancer surgery,and promote faster recovery of intestinal function.
Objective:To explore the effects of dexmedetomidine on intestinal function in patients with radical operation of cervical carcinoma.Methods:92 patients with radical operation of cervical carcinoma of the First People's Hospital in Yibin from October 2016 to June 2018 were selected as the subjects.According to the random digital table method,92 patients were divided into observation group and control group,and 46 cases in each group.The observation group was intravenously infused with 0.5 μg/kg dexmedetomidine for 10 minutes before the induction of anesthesia,then pumped continuously with 0.4 μg/(kg·h) until 40 minutes before operation.The control group was given intravenously with the equal volume of normal saline.The two groups were given with propofol and remifentanil analgesia.The inflammatory factors(IL-6,TNF-α) and indicators of intestinal permeability(DAO and D-LAC) were monitored before the administration(T1),at the end of operation(T2),2 h after operation(T3) and 24 h after operation(T4).The hospitalization time and bowel function recovery were compared between the two groups.Results:At T2,T3 and T4,serum IL-6,TNF-α levels in observation group were lower than those in control group(P<0.05).At T2,T3 and T4,serum DAO and D-LAC levels in observation group were lower than those in control group(P<0.05).The recovery time of bowel sounds,first defecation time and total hospitalization time of the observation group were shorter than those of the control group(P<0.05).Conclusion:Dexmedetomidine can alleviate inflammatory reaction and intestinal mucosal injury in patients undergoing radical cervical cancer surgery,and promote faster recovery of intestinal function.
引文
[1] ZHANG LL,LI DK,RONG H,et al.Clinical comparison of laparoscopy and laparotomy in the treatment of early cervical cancer[J].Chinese Journal of Clinical Healthcare,2017,20(2):204-206.[张玲玲,李大可,荣慧,等.经腹腔镜与开腹手术治疗早期宫颈癌的临床对比[J].中国临床保健杂志,2017,20(2):204-206.]
[2] SONG Y,HU BJ,LU XY,et al.Dexmedetomidine on hemodynamics and stress response in patients undergoing laparoscopic hysterectomy[J].Progress in Modern Biomedicine,2016,16(5):898-890.[宋颖,胡宝吉,陆晓英,等.右美托咪定对腹腔镜子宫切除术患者血流动力学及应激反应的影响[J].现代生物医学进展,2016,16(5):898-890.]
[3] Weerink Mas,Struys M Mrf,Hannivoort LN,et al.Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J].Clin Pharmacokinet,2017,56(8):893-913.
[4] WANG Y,JIANG LL,CHENG J,et al.Effect of dexmedetomidine on oxidative stress in patients undergoing laparoscopic total hysterectomy[J].Anhui Med J,2015,19(6):1171-1174.[王勇,蒋玲玲,程洁,等.右美托咪定对腹腔镜全子宫切除术患者氧化应激反应的影响[J].安徽医学,2015,19(6):1171-1174.]
[5] Wang ZX,Huang CY,Hua YP,et al.Dexmedetomidine reduces intestinal and hepatic injury after hepatectomy with inflow occlusion under general anaesthexia:A randomized controlled trial[J].Br J Anaesth,2014,112(6):1055-1064.
[6] Li Y,Wang B,Zhang LL,et al.Dexmedetomidine combined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique[J].Anesth Analg,2016,122(4):1202-1210.
[7] Liang X,Zhou M,Feng JJ,et al.Efficacy of dexmedetomidine on postoperative nausea and vomiting:A meta-analysis of randomized controlled trials[J].Int J Clin Exp Med,2015,8(6):8450-8471.
[8] ZHANG N,XU LS.Effects of dexmedetomidine combined with lidocaine on oxidative stress and inflammatory response in laparoscopic hysterectomy patients[J].Chin Med Herald,2018,15(10):95-99.[张努,徐连生.右美托咪定联合利多卡因静脉输注对腹腔镜全子宫切除术患者氧化应激水平及炎性反应的影响[J].中国医药导报,2018,15(10):95-99.]
[9] SHANG Y,ZHAO LY,LU JK.Relationship between inflammatory cytokines and gastric cancer[J].J Chin Pharm Univ,2015,46(01):123-128.[尚颖,赵立元,陆景坤.炎性细胞因子与胃癌的关系[J].中国药科大学学报,2015,46(01):123-128.]
[10] Bulow NMH,Colpo E,Pereira RP,et al.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass[J].Braz J Med Biol Res,2016,49(4):e4646.
[11] Si YN,Bao HG,Han L,et al.Dexmedetomidine protects against renal ischemia and reperfusion injury by inhibiting the JAK/STAT signaling activation[J].J Transl Med,2013(11):141.
[12] LIU JQ,CAO JC.Progress in treatment of intestinal mucosal barrier dysfunction[J].Chinese Journal of Difficult and Complicated Cases,2013,5(6):315-317.[刘继前,曹建春.肠黏膜屏障功能障碍治疗进展[J].疑难病杂志,2013,5(6):315-317.]
[13] Mitsuoka H,Schmid-Sehobein GW.Mech-anisms for blockade of in vivo activator production in the ischemic intestine and multi- organ failure[J].Shock,2013,14(6):522-527.
[14] Al-Shibli A,Al Tatari H,Al Ameri A,et al.Uric acid excretion in rotavirus gastro-enteritis[J].Paediatr Int Child Health,2014,34(1):19-23.
[15] HOU Y,GONG P,YANG Y,et al.Clinical application progress of determination of serum two amine oxidase[J].Chinese Journal of Laboratory Diagnosis,2015,19(11):1985-1987.[侯玥,宫平,杨羽,等.血清二胺氧化酶测定的临床应用进展[J].中国实验诊断学,2015,19(11):1985-1987.]
[16] Mihajlovic DM,Lendak DF,Brkic SV,et al.Endocan is useful biomarker of survival and severity in sepsis[J].Microvasc Res,2014(93):92-97.
[17] Yeh YC,Wu CY,Cheng YJ,et al.Effects of dexmedetomidine on intestinal microcirculation and intestinal epithelial barrier in endotoxemic rats[J].Anesthesiology,2016,125(2):355-367.
[18] ZHANG Y,ZHAO QH,ZHANG YC,et al.Effects of dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement[J].Chinese Journal of General Practice,2018,16(7):1078-1080.[张颖,赵其宏,张运淳,等.右美托咪定对心瓣膜置换术患者应激反应与肠黏膜屏障功能的影响[J].中华全科医学,2018,16(7):1078-1080.]
[2] SONG Y,HU BJ,LU XY,et al.Dexmedetomidine on hemodynamics and stress response in patients undergoing laparoscopic hysterectomy[J].Progress in Modern Biomedicine,2016,16(5):898-890.[宋颖,胡宝吉,陆晓英,等.右美托咪定对腹腔镜子宫切除术患者血流动力学及应激反应的影响[J].现代生物医学进展,2016,16(5):898-890.]
[3] Weerink Mas,Struys M Mrf,Hannivoort LN,et al.Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J].Clin Pharmacokinet,2017,56(8):893-913.
[4] WANG Y,JIANG LL,CHENG J,et al.Effect of dexmedetomidine on oxidative stress in patients undergoing laparoscopic total hysterectomy[J].Anhui Med J,2015,19(6):1171-1174.[王勇,蒋玲玲,程洁,等.右美托咪定对腹腔镜全子宫切除术患者氧化应激反应的影响[J].安徽医学,2015,19(6):1171-1174.]
[5] Wang ZX,Huang CY,Hua YP,et al.Dexmedetomidine reduces intestinal and hepatic injury after hepatectomy with inflow occlusion under general anaesthexia:A randomized controlled trial[J].Br J Anaesth,2014,112(6):1055-1064.
[6] Li Y,Wang B,Zhang LL,et al.Dexmedetomidine combined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique[J].Anesth Analg,2016,122(4):1202-1210.
[7] Liang X,Zhou M,Feng JJ,et al.Efficacy of dexmedetomidine on postoperative nausea and vomiting:A meta-analysis of randomized controlled trials[J].Int J Clin Exp Med,2015,8(6):8450-8471.
[8] ZHANG N,XU LS.Effects of dexmedetomidine combined with lidocaine on oxidative stress and inflammatory response in laparoscopic hysterectomy patients[J].Chin Med Herald,2018,15(10):95-99.[张努,徐连生.右美托咪定联合利多卡因静脉输注对腹腔镜全子宫切除术患者氧化应激水平及炎性反应的影响[J].中国医药导报,2018,15(10):95-99.]
[9] SHANG Y,ZHAO LY,LU JK.Relationship between inflammatory cytokines and gastric cancer[J].J Chin Pharm Univ,2015,46(01):123-128.[尚颖,赵立元,陆景坤.炎性细胞因子与胃癌的关系[J].中国药科大学学报,2015,46(01):123-128.]
[10] Bulow NMH,Colpo E,Pereira RP,et al.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass[J].Braz J Med Biol Res,2016,49(4):e4646.
[11] Si YN,Bao HG,Han L,et al.Dexmedetomidine protects against renal ischemia and reperfusion injury by inhibiting the JAK/STAT signaling activation[J].J Transl Med,2013(11):141.
[12] LIU JQ,CAO JC.Progress in treatment of intestinal mucosal barrier dysfunction[J].Chinese Journal of Difficult and Complicated Cases,2013,5(6):315-317.[刘继前,曹建春.肠黏膜屏障功能障碍治疗进展[J].疑难病杂志,2013,5(6):315-317.]
[13] Mitsuoka H,Schmid-Sehobein GW.Mech-anisms for blockade of in vivo activator production in the ischemic intestine and multi- organ failure[J].Shock,2013,14(6):522-527.
[14] Al-Shibli A,Al Tatari H,Al Ameri A,et al.Uric acid excretion in rotavirus gastro-enteritis[J].Paediatr Int Child Health,2014,34(1):19-23.
[15] HOU Y,GONG P,YANG Y,et al.Clinical application progress of determination of serum two amine oxidase[J].Chinese Journal of Laboratory Diagnosis,2015,19(11):1985-1987.[侯玥,宫平,杨羽,等.血清二胺氧化酶测定的临床应用进展[J].中国实验诊断学,2015,19(11):1985-1987.]
[16] Mihajlovic DM,Lendak DF,Brkic SV,et al.Endocan is useful biomarker of survival and severity in sepsis[J].Microvasc Res,2014(93):92-97.
[17] Yeh YC,Wu CY,Cheng YJ,et al.Effects of dexmedetomidine on intestinal microcirculation and intestinal epithelial barrier in endotoxemic rats[J].Anesthesiology,2016,125(2):355-367.
[18] ZHANG Y,ZHAO QH,ZHANG YC,et al.Effects of dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement[J].Chinese Journal of General Practice,2018,16(7):1078-1080.[张颖,赵其宏,张运淳,等.右美托咪定对心瓣膜置换术患者应激反应与肠黏膜屏障功能的影响[J].中华全科医学,2018,16(7):1078-1080.]