摘要
目的评价与分析右美托咪定对老年行腹腔镜下直肠癌根治术患者围术期应激反应及免疫功能的影响。方法选取2014年1月~2016年1月笔者医院收治的择期行腹腔镜下直肠癌根治术的老年患者180例为研究对象,ASA分级Ⅰ~Ⅱ级。采用随机数字表法将上述研究对象分为观察组(90例)和对照组(90例),观察组通过在麻醉诱导前30min给予负荷剂量的右美托咪定(0.5μg/kg),然后以维持剂量0.3μg/(kg·h)的速率输注至手术结束。而对照组患者给予等负荷量和维持剂量的生理盐水。分别在不同时间点,包括麻醉前(T_1)、患者手术结束时(T_2)、患者手术结束后30min(T_3)及患者手术结束后24h(T_4)记录其血流动力学指标如心率(HR)、平均动脉压(MAP)及外周血氧饱和度(SpO_2)水平。通过运用酶联免疫吸附法(ELISA)测定两组患者各时间点应激指标如血浆肾上腺素、去甲肾上腺素及皮质醇(COR)水平,采用流式细胞仪检测其T淋巴细胞亚群和NK细胞水平。结果与T_1时点比较,对照组T_2、T_3时点的MAP显著升高,HR显著加快,而观察组MAP明显降低,HR显著减慢(P<0.05)。通过与对照组患者比较,观察组T_2、T_3时点MAP显著降低,HR显著减慢(P<0.05),两组患者各时间点SpO_2比较,差异无统计学意义(P>0.05)。与对照组比较,观察组在T_2、T_3和T_4时点应激指标包括血糖、皮质醇、血浆肾上腺素和去甲肾上腺素水平明显降低(P<0.05);与对照组比较,观察组患者在T_2、T_3和T_4时点CD3^+、CD4^+、CD4^+/CD8^+和NK细胞水平显著升高(P<0.05)。结论右美托咪定可显著降低老年行腹腔镜下直肠癌根治术患者围术期的应激反应,改善其机体细胞免疫功能,有利于促进患者术后康复。
Objective To evaluate and analyse the effect of dexmedetomidine on perioperative stress and immunefunction in elderly patients with rectal tumors undergoing radical operation by laparoseopy. Methods A total of 180 ASA I or 11 elderly patients with rectal cancer undergoing radical operation by laparoscopy in our hospital from January 2014 to January 2016 were enrolled in the study. These patients were divided into observation group （90 cases） and control group （90 cases） by random digital table. A loading dose of dexme- detomidine with O. 5μg/kg was givenat 30 min before induction of anesthesia, and followed by infusion at 0.3μg/（ kg h） until the end of operation in observation group, and the equal loading dose and rateof normal saline was given in control group. The heart rate （HR） , mean arterial pressure （MAP） and oxygen saturation （ SpO2 ） were recorded respectively before anesthesia （ T1 ）, and after operation （T2） , 30min after operation （T3 ） and 24h after operation （T4 ）. The levels of adrenaline, norepinephrine and cortisol （COR） were measured by enzyme -linked immunosorbent assay （ELISA）. The T lymohocyte subpopulations and NK cell levels in plasma were meas- ured by flow cytometry. Results Compared with T1 , the MAP and HR were significant increased in control group at T2 and T3 , while the MAP and HR were significant decreased in observation group （P 〈 0.05）. Compared with control group, the MAP and HR were signifi- cant decreased in observation group at T2 and T3 （P 〈0.05） , however there was no significant difference in SpO2between control and ob- servation group （P 〉 0. 05）. Compared with control group, the levels of blood glucose, eortisol, plasma epinephrine and norepinephrine were significant decreasedat T2 , T3 and T4 （P 〈 0.05）. Compared with control group, the levels of CD3＋ , CD4＋ ,CD4 ＋/CD8＋ and NK cells in peripheral blood were significant higher at T2 , T3 and T4 （P 〈 0.05）. Conclusion Dexmedetomidine assisting anesthesia can significantly ease the perioperative stress response and lower the influence of anesthesia and surgical trauma on the cellular immune func- tion in elderly patients undergoing radical operation by laparoscopy for reatal cancer, which is beneficial to the postoperative rehabilitation.
出处
《医学研究杂志》
2017年第8期145-149,共5页
Journal of Medical Research
关键词
右美托咪定
老年
直肠癌
应激
免疫功能
Dexmedetomidine
Elderly
Rectal cancer
Stress
Immunologic function
