摘要
目的:探讨高剂量右美托咪定在腹腔镜下子宫恶性肿瘤手术患者中的应用效果,并分析对术后肠屏障功能的影响。方法:采用简单随机法将2020年12月至2022年12月期间于郑州大学附属郑州中心医院麻醉与围术期医学科择期行腹腔镜下子宫恶性肿瘤手术治疗的91例患者分为低剂量组[n=45,接受低剂量0.5μg·kg-1·h-1右美托咪定处理]和高剂量组[n=46,接受高剂量1.0μg·kg-1·h-1右美托咪定处理],比较两组围术期指标(手术时间、苏醒时间、首次排气时间、术中舒芬太尼、丙泊酚使用量)、血流动力学(血压、平均动脉压、心率)、创伤性应激水平(白细胞介素-2受体、肿瘤坏死因子-α、白细胞介素-6)、肠屏障功能[紧密连接蛋白1(claudin-1)及二胺氧化酶(DAO)]、不良反应发生率。结果:高剂量组苏醒时间长于低剂量组,首次排气时间短于低剂量组,差异有统计学意义(P<0.05),两组舒芬太尼、丙泊酚用量和手术时间比较差异无统计学意义(P>0.05);麻醉诱导后10 min(T2)时,高剂量组收缩压、舒张压低于低剂量组,建立气腹后(T3)、术毕(T4)时,高剂量组血流动力学指标水平均低于低剂量组,差异均有统计学意义(P<0.05);低剂量组T3、T4时的平均动脉压、心率均高于麻醉诱导前(T1)、T2,差异有统计学意义(P<0.05),而高剂量组组内比较差异无统计学意义(P>0.05);T2、T4、解除气腹后12 h(T5)时,两组创伤性应激指标水平均高于T1,且高剂量组均低于低剂量组,差异均有统计学意义(P<0.05);T4、T5时,低剂量组claudin-1均低于T1,且高剂量组claudin-1均高于低剂量组,差异均有统计学意义(P<0.05);T5时,两组DAO均高于T1,且高剂量组低于低剂量组,差异有统计学意义(P<0.05);两组不良反应总发生率比较差异无统计学意义(χ2=3.068,P=0.080)。结论:高剂量右美托咪定可有效维持腹腔镜下子宫恶性肿瘤手术患者血流动力学的稳定,显著减轻术中炎症反应,并能通过遏制claudin-1水平的下调和DAO水平的上调来稳定肠屏障功能,但术后苏醒质量劣于低剂量。
Objective:To investigate the effect of high-dose dexmedetomidine on postoperative intestinal barrier function in patients undergoing laparoscopic uterine malignant tumors surgery,and analyze the effect on postoperative intestinal barrier function.Methods:A total of 91 patients who underwent elective laparoscopic surgery for uterine malignant tumors in the Department of Anesthesiology and Perioperative Medicine of Zhengzhou Central Hospital Affiliated to Zhengzhou University from December 2020 to December 2022 were selected and divided into low dose group[n=45,receiving low-dose 0.5μg/(kg·h)dexmedetomidine treatment]and high dose group[n=46,receiving high-dose 1.0μg/(kg·h)dexmedetomidine treatment]by simple random method.The perioperative indexes(operation time,recovery time,first exhaust time,intraoperative sufentanil and propofol dosage),hemodynamics(blood pressure,mean arterial pressure and heart rate),traumatic stress level(interleukin-2 receptor,tumor necrosis factor-α,interleukin-6),intestinal barrier function[claudin-1 and diamine oxidase(DAO)]and incidence of adverse reactions were compared between the two groups.Results:The awakening time of high dose group was longer than that of low dose group,and the first exhaust time was shorter than low dose group,with statistical significance(P<0.05).The dosage of sufentanil and propofol and the operation time were not significantly different between the two groups(P>0.05).Ten minutes after induction of anesthesia(T2),systolic blood pressure and diastolic blood pressure in high dose group were lower than low dose group.After establishing pneumoperitoneum(T3)and at the end of the operation(T4),the levels of hemodynamic indexes in high dose group was lower than low dose group,with statistical significance(P<0.05).Average arterial pressure and heart rate at T3 and T4 in low dose group were higher than those at T1 and T2,with statistical significance(P<0.05),but there was no statistical difference in the high-dose group(P>0.05).At T2,T4 and 12 hours after pneumnoperitoneum release(T5),the levels of traumatic stress indicators in the two groups were higher than T1,and those in high dose group were lower than low dose group,with statistical significance(P<0.05).At T4 and T5,claudin-1 in low dose group was lower than T1,claudin-1 in high dose group was higher than low dose group,with statistical significance(P<0.05).At T5,the level of DAO in both groups was higher than T1,the high dose group was lower than the low dose group,with statistical significance(P<0.05).Total incidence of adverse reactions between the two groups was not statistically significant.(χ2=3.068,P=0.080).Conclusions:High-dose dexmedetomidine can effectively maintain the stability of hemodynamics in patients undergoing laparoscopic uterine malignant tumor surgery,significantly reduce the inflammatory reaction during operation,and stabilize the intestinal barrier function by inhibiting the down-regulation of claudin-1 level and the up-regulation of DAO level,but the quality of postoperative recovery is inferior to that of low-dose dexmedetomidine.
作者
郭志鹏
冯锋
王其敏
Guo Zhipeng;Feng Feng;Wang Qimin(Department of Anesthesiology and Perioperative Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450000,China)
出处
《感染、炎症、修复》
2024年第4期312-316,共5页
Infection Inflammation Repair
关键词
右美托咪定
腹腔镜
子宫恶性肿瘤
紧密连接蛋白
肠屏障功能
Dexmedetomidine
Laparoscopy
Uterine malignancy
Claudin-1 protein
Intestinal barrier function
