子宫切除术前给予右美托咪定对患者应激和免疫功能的影响

发布时间：2018-08-07 09:26

【摘要】：目的:探讨右美托咪定对子宫切除术患者应激及免疫功能的影响,旨在为临床麻醉用药提供依据。方法:选取子宫肌瘤且需行择期子宫切除术患者60例,ASAⅠ-Ⅱ级,依据预输注药物不同分为观察组和对照组,每组30例,观察组患者麻醉前给予负荷剂量右美托咪定静脉泵注,剂量1μg·kg-1,浓度4mg·L-1,泵注时间10min,对照组患者给予等量生理盐水泵注。2组均在泵注10min后开始诱导,麻醉中2组患者均使用七氟醚和芬太尼维持;2组患者于入室前(T0)、手术2h(T1)和术后拔管时(T2)采血,检测血清皮质醇(COR)和白细胞介素2(IL-2)浓度,并检测血浆T淋巴细胞亚群和NK细胞水平。结果:2组患者T0时血清COR和IL-2浓度比较差异无统计学意义(P0.05);2组患者T2时COR浓度明显高于T0时(P0.05);观察组T2时COR浓度明显低于对照组(P0.05);随手术时间延长2组患者血清IL-2浓度呈下降趋势,观察组T2时血清IL-2浓度明显高于对照组(P0.05);2组患者T0时CD3+、CD4+、CD8+、CD4+/CD8+和NK水平比较差异无统计学意义(P0.05);2组患者各时间点CD8+水平比较差异均无统计学意义(P0.05);对照组患者T1和T2时CD3+、CD4+、CD4+/CD8+及NK水平均明显低于T0时(P0.05);观察组T2时CD3+、CD4+、CD4+/CD8+和NK水平均明显高于对照组(P0.05)。结论:右美托咪定辅助麻醉可减轻患者术后应激反应,降低麻醉及手术创伤对机体细胞免疫功能的影响,利于患者术后康复。
[Abstract]:Objective: to investigate the effect of dexmetomidine on stress and immune function in patients undergoing hysterectomy. Methods: sixty patients with uterine leiomyoma who needed selective hysterectomy were divided into observation group and control group, 30 cases in each group. The patients in the observation group were given dexmetomidine intravenous pump before anesthesia. The dose of 1 渭 g kg-1, the concentration of 4mg L-1, and the time of pump injection for 10 minutes. The control group was treated with the same amount of normal saline and the group of 2 was induced by 10min. During anesthesia, sevoflurane and fentanyl were used to maintain the blood samples of both groups before entering room (T0), 2 hours after operation (T1) and after extubation (T2). Serum cortisol (COR) and interleukin 2 (IL-2) were measured. Plasma T lymphocyte subsets and NK cells were measured. Results there was no significant difference in the concentration of COR and IL-2 between the two groups at T0 (P0.05). The concentration of COR in T2 was significantly higher than that in T0 (P0.05), the COR concentration in T2 in observation group was significantly lower than that in control group (P0.05), and the serum concentration in two groups was prolonged with the operation time (P0.05). The concentration of IL-2 decreased, The serum IL-2 concentration at T2 in the observation group was significantly higher than that in the control group (P0.05). There was no significant difference in the levels of CD3 CD4 / CD8 + CD8 / CD8 and NK between the two groups at T0 (P0.05), and there was no significant difference in the CD8 level at all time points between the two groups (P0.05), while in the control group there was no significant difference (P0.05). The levels of CD4 / CD8 and NK in T _ 1 and T _ 2 were significantly lower than those in T _ 0 (P0.05), and the levels of CD4 _ 4 / CD _ 8 and NK in T _ 2 in the observation group were significantly higher than those in the control group (P0.05). Conclusion: dexmetomidine adjuvant anesthesia can reduce the postoperative stress response, reduce the effect of anesthesia and surgical trauma on the cellular immune function of the patients, and benefit the postoperative rehabilitation of the patients.
【作者单位】：河北省唐山市工人医院麻醉科;
【基金】：河北省科技厅科技发展项目资助课题(20091748)
【分类号】：R614

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