摘要
目的探讨维生素C注射液联合右美托咪定对口腔颌面部恶性肿瘤患者术后炎症反应和氧化应激的影响。方法选择择期行口腔颌面部恶性肿瘤根治术患者72例,男47例,女25例,年龄29-82岁,BMI 20-31 kg/m^(2),ASAⅠ或Ⅱ级,所有患者术毕保留气管导管或气切套管入中心ICU。采用随机数字表法分为两组:观察组和对照组,每组36例。所有患者术后给予常规机械通气、镇痛镇静、预防性抗感染、消肿、营养支持等治疗,对照组10 min内静脉泵入右美托咪定0.5μg/kg,继之以0.4μg•kg^(-1)•h^(-1)持续静脉泵入,维持3 d后停药;观察组在对照组的基础上静脉滴注维生素C注射液3 g(以5%葡萄糖注射液500 ml稀释),每日1次,连续3 d。于用药前、用药后1、3、7 d检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)浓度。记录术后出血、术区感染、胃肠道功能紊乱、低血压、心动过缓、头晕、晕厥等并发症的发生情况。结果与用药前比较,用药后1、3、7 d两组血清TNF-α、CRP浓度明显降低(P<0.05),用药后7 d两组血清IL-6浓度明显降低(P<0.05)。与对照组比较,用药后1、3、7 d观察组血清TNF-α、IL-6、CRP浓度明显降低(P<0.05)。与用药前比较,用药后1、3、7 d两组血清MDA浓度明显降低(P<0.05),血清SOD、CAT、GSH-Px浓度明显升高(P<0.05)。与对照组比较,用药后1、3、7 d观察组血清MDA浓度明显降低(P<0.05),血清SOD、CAT、GSH-Px浓度明显升高(P<0.05)。与对照组比较,观察组术后出血、术区感染、胃肠道功能紊乱发生率明显降低(P<0.05)。两组低血压、心动过缓、头晕等发生率差异无统计学意义。结论与单用右美托咪定比较,联合使用维生素C注射液和右美托咪定治疗可有效降低口腔颌面部肿瘤术后患者炎症反应和氧化应激反应,减少术后并发症的发生。
Objective To investigate the effect of vitamin C injection combined with dexmedetomidine on inflammatory response and oxidative stress in postoperative patients with oral and maxillofacial malignant tumor.Methods Seventy-two patients with oral and maxillofacial malignant tumor treated in our hospital,47 males and 25 females,aged 29-82 years,BMI 20-31 kg/m^(2),ASA physical statusⅠorⅡ,were selected and divided into observation group and control group according to the random number table method,with 36 cases in each group.All patients were given routine treatment,including mechanical ventilation,analgesia and sedation,preventive anti-infection therapy,detumescence and nutrition therapy.Patients in the control group received 1μg/kg bolus dose of dexmedetomidine intravenously with 10 minutes after operation immediately,followed by a continuous dose of 0.4μg•kg^(-1)•h^(-1) for three days,on top of which,the experimental group was additionally given vitamin C injection 3 g(diluted with 5%glucose injection 500 ml)intravenously,once a day,for 3 consecutive days.The levels of TNF-α,IL-6,C-reactive protein(CRP)and malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)were compared between the two groups before administration,1 day,3 days,and 7 days after administration.Postoperative bleeding,infection,gastrointestinal dysfunction,hypotension,bradycardia,dizziness,syncope and other complications were recorded.Results Serum levels of inflammatory factors(TNF-αand CRP)were significantly decreased 1 day,3 days,and 7 days after administration in both groups compared with those before administration(P<0.05).Serum levels of IL-6 were decreased 7 days after administration in both groups compared with those before administration(P<0.05).Compared with the control group,serum levels of TNF-α,IL-6 and CRP were significantly decreased before administration,1 day,3 days,and 7 days after administration in the observation group(P<0.05).Compared with those before administration,serum levels of MDA were decreased significantly 1 day,3 days,and 7 days after administration in both groups(P<0.05).Compared with the control group,the concentrations of serum MDA were significantly decreased before administration 1 day,3 days,and 7 days after administration in the observation group(P<0.05).Serum levels of SOD,CAT,GSH-Px were increased 1 day,3 days,and 7 days after administration in both groups compared with those before administration(P<0.05).Compared with the control group,the concentrations of serum SOD,CAT,GSH-Px were significantly increased before administration,1 day,3 days,and 7 days after administration in the observation group(P<0.05).The incidences of postoperative hemorrhage,incision infection and gastrointestinal dysfunction in the observation group were all significantly lower than those in the control group(P<0.05).There was no significant difference in the incidences of bradycardia,hypotension and dizziness between the two groups.Conclusion Compared with dexmedetomidine alone,vitamin C injection combined with dexmedetomidine used for patients with oral and maxillofacial malignant tumor can alleviate the inflammatory response and oxidative stress,and reduce the incidence of complications.
作者
徐丽
张玉坤
陈军
嵇富海
杨建平
XU Li;ZHANG Yukun;CHEN Jun;JI Fuhai;YANG Jianping(Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2021年第10期1065-1069,共5页
Journal of Clinical Anesthesiology
基金
苏州市民生科技项目(SYS2018038)。
关键词
口腔颌面部恶性肿瘤
维生素C注射液
右美托咪定
炎症反应
氧化应激
Oral and maxillofacial malignant tumor
Vitamin C injection
Dexmedetomidine
Inflammatory response
Oxidative stress
