依托咪酯持续静脉麻醉对老年腹腔镜下胃癌根治术患者循环及细胞免疫功能的影响

发布时间：2018-06-22 15:43

本文选题：依托咪酯 + 胃癌根治术　；参考：《中国老年学杂志》2017年17期

【摘要】：目的探讨依托咪酯持续静脉麻醉对老年腹腔镜下胃癌根治术患者循环及细胞免疫功能的影响。方法 86例老年择期行腹腔镜下胃癌根治术患者随机分为试验组(n=42)和对照组(n=44),在常规麻醉诱导基础上,试验组给予依托咪酯0.3 mg/kg静注,对照组给予丙泊酚2 mg/kg静注,麻醉维持期间,试验组给予依托咪酯0.4~0.8 mg·kg~(-1)·h~(-1)持续静脉输注,对照组给予丙泊酚4~8 mg·kg~(-1)·h~(-1)持续静脉输注。分别于两组麻醉前10 min(T0)、麻醉诱导结束(T1)、插管后(T2)、术毕(T3)时记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR),分别于T0、T3、术后12 h(T4)、24 h(T5)和48 h(T6)时,利用放射免疫分析法对血糖、肾上腺素和皮质醇水平进行检测,利用FACSCalibur流式细胞仪对免疫细胞亚群CD3~+、CD4~+、CD8~+和自然杀伤(NK)细胞进行检测,计算CD4~+/CD8~+比值。结果与T0时相比,两组T1~2时SBP、DBP和MAP均降低,T1时HR降低,试验组T1~2时SBP、DBP和MAP均高于对照组,T1时HR高于对照组(P0.05);与T0时相比,两组T3~4时血糖、肾上腺素和皮质醇水平均升高,且试验组均低于对照组(P0.05);与T0时相比,两组T4~5时CD3~+、CD4~+、CD4~+/CD8~+比值和NK细胞比例均降低(P0.05),两组各时点CD8~+无统计学差异(P0.05);试验组T4~5时CD3~+、CD4~+、CD4~+/CD8~+比值和NK细胞比例均高于对照组(P0.05)。结论依托咪酯持续静脉麻醉应用于老年腹腔镜下胃癌根治术可减少对循环系统及围术期应激反应的影响,改善患者围术期细胞免疫功能。
[Abstract]:Objective to investigate the effects of continuous intravenous anesthesia with etomidate on circulation and cellular immune function in elderly patients undergoing laparoscopic radical gastrectomy. Methods 86 elderly patients undergoing laparoscopic radical gastrectomy were randomly divided into two groups: the experimental group (n = 42) and the control group (n = 44). On the basis of routine anesthesia induction, etomidate 0.3 mg/kg was given intravenously in the experimental group and propofol 2 mg/kg intravenously in the control group. During the maintenance of anesthesia, etomidate 0.4 mg kg ~ (-1) h ~ (-1) was given to the experimental group and propofol 48 mg kg ~ (-1) h ~ (-1) was given to the control group. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (map) and heart rate (HR) were recorded at 10 min before anesthesia (T0), at the end of anesthesia induction (T1), after intubation (T2), at the end of operation (T3), at T0 T3, at 12 h (T4) 24 h (T5) and 48 h (T6). The levels of epinephrine and cortisol were detected by FACSCalibur flow cytometry. The immunocytic subsets CD3 ~ + CD4 ~ + CD8 ~ and natural killer (NK) cells were detected and the ratio of CD _ 4 ~ / CD _ 8 ~ was calculated. Results compared with T0, the HR of SBPnDBP and map decreased at T1 in both groups. The HR of T1-2 SBPndP and map in the experimental group was higher than that in the control group (P0.05), and the levels of blood glucose, adrenaline and cortisol in T3 ~ 4 group were higher than those in the control group (P0.05), and the levels of blood glucose, adrenaline and cortisol in T3 ~ 4 group were higher than those in T3 ~ 4 group (P0.05). Compared with the control group, the ratio of CD4 / CD4 / CD8 ~ / CD4 ~ / CD8 ~ and NK cells in the two groups were lower than those in the control group (P0.05), but there was no significant difference between the two groups at each time point (P0.05); the ratio of CD3 ~ CD4- CD4- / CD8 ~ and the percentage of NK cells in the test group were higher than those in the control group (P0.05). Conclusion continuous intravenous anesthesia with etomidate can reduce the effect of laparoscopic radical gastrectomy on the circulatory system and perioperative stress response and improve the cellular immune function of patients with gastric cancer during perioperative period.
【作者单位】：贵州省人民医院;贵州医科大学附属医院;
【分类号】：R614;R735.2

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