右美托咪定对肝炎肝硬化患者围术期应激反应和免疫功能的影响

发布时间：2018-02-21 06:11

本文关键词： 右美托咪定肝炎肝硬化肝癌切除术应激反应免疫功能　出处：《临床麻醉学杂志》2016年07期 　论文类型：期刊论文

【摘要】：目的观察右美托咪定对肝炎肝硬化患者围术期应激反应和免疫功能的影响。方法择期行肝癌切除术的肝炎肝硬化患者40例,肝功能分级(Child-Pugh)为A或B级,ASAⅡ或Ⅲ级,采用数字表法随机均分为右美托咪定组(D组)和对照组(C组)。D组麻醉诱导前10min静脉泵注右美托咪定0.5μg/kg,随后以0.4μg·kg-1·h-1持续泵注至关腹;C组静脉泵注等量生理盐水。分别于麻醉诱导前30min(T0)、术毕即刻(T1)、术后24h(T2)、48h(T3)抽取外周静脉血,采用流式细胞仪测定T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)数量、NK细胞的百分比;并采用酶联免疫分析法检测T0~T3时血清炎性因子(IL-2、IL-10)浓度及T0、T2、T3时血清皮质醇(Cor)、醛固酮(ALD)、促肾上腺皮质激素(ACTH)含量。记录T0、插管即刻(Ta)、T1、拔管即刻(Tb)时SBP、DBP及CVP。结果 T1、T2时两组CD3+、CD4+、CD8+、CD4+/CD8+明显低于T0时,且C组明显低于D组(P0.05)。T1时两组NK细胞明显高于T0时,D组明显高于C组(P0.05)。T1、T2时C组IL-2浓度明显低于T0时和D组,T2、T3时C组IL-10浓度明显高于T0时和D组(P0.05)。T2、T3时两组Cor、ALD、ACTH水平明显高于T0时,D组Cor、ALD、ACTH水平明显低于C组(P0.05)。Ta、T1、Tb时C组SBP、DBP、CVP明显高于T0时和D组(P0.05)。结论全麻下行肝癌切除术的肝炎肝硬化患者在术后存在一定程度的免疫抑制,静脉泵注右美托咪定可以抑制围术期的应激反应,降低对免疫功能的影响。
[Abstract]:Objective to observe the effect of dexmetomidine on perioperative stress response and immune function in patients with liver cirrhosis. All patients were randomly divided into dexmetomidine group (group D) and control group (group C, n = 10). Dexmetomidine 0.5 渭 g / kg was injected intravenously 10 minutes before anesthesia induction, and then 0.4 渭 g 路kg-1 路h -1 continuous pump was injected into group C with the same amount of normal saline. Peripheral venous blood was drawn 30 minutes before anesthesia induction, and immediately after operation, T _ 1 and T _ (2) and 48 h / T _ (3) were collected. The percentage of NK cells in T lymphocyte subsets (CD3, CD 4, CD 8, CD 4 / CD 8) was determined by flow cytometry. The levels of serum inflammatory factor IL-2IL-10 at T0 T 3 and serum cortisol Corn, aldosterone ALDN and adrenocorticotropic hormone (ACTH) at T0 T 3 and T 2 T 3 were determined by Elisa. The T0, T0 and T1 were recorded and SBPtP and CVP were recorded at T1 T 2 and T 1 T 2. Results the results were as follows: (1) T _ 1 T _ 2, T _ 1 T _ 2, T _ 1 T _ 2, T _ 1 T _ 2, T _ 1 T _ 2, T _ 1 T _ 2, T _ 1 T _ 2, respectively. When CD3, CD 4, CD 8, CD 4 / CD 8 were significantly lower than those of T 0, And the NK cells in group C were significantly lower than those in group D (P 0.05N. T1) and higher than those in group D (P 0.05). T _ 1 T _ 2 was significantly higher than that in group C at T _ 0 and T _ 2T _ 3. The level of IL-10 in group C was significantly higher than that in group T _ 0 and group D at P 0.05 .T _ 2T _ 3, and the level of IL-2 in group C was significantly higher than that in group D at T _ 0 and T _ 2T _ 3, respectively, and the level of IL-10 in group C was significantly higher than that in group D at T _ 0 and T _ 2T _ 3. The level of ACTH in group D was significantly lower than that in group C (P 0.05N. Tahl T1Tb). The level of CVP in group C was significantly higher than that in group T 0 and group D (P 0.05). Conclusion there is a certain degree of immunosuppression in patients with hepatocirrhosis undergoing hepatectomy under general anesthesia, and the level of ACTH in group C is significantly higher than that in group C (P 0) and group D (P 0.05). Intravenous injection of dexmetidine inhibited stress response and decreased immune function during perioperative period.
【作者单位】：南京医科大学第一附属医院麻醉科;东南大学附属第二医院麻醉科;
【分类号】：R614

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