摘要目的:评价右美托咪定复合麻醉对急性肠梗阻患者肠道屏障功能的影响。方法:选择胃肠外科及肛肠科住院手术治疗的急性肠梗阻患者94例，年龄33～81岁，体重48～80 kg，ASA分级Ⅰ或Ⅱ级。按随机数字表法将患者分为2组( n＝47)：常规麻醉组(R组)和右美托咪定复合麻醉组(D组)。D组在全麻诱导前静脉注射右美托咪定负荷剂量1 μg/kg 15 min，随后以0.5 μg·kg -1·h -1速率静脉输注至术毕前30 min。于右美托咪定负荷剂量输注前(T 0)、术后1 d(T 1)、术后3 d(T 2)和术后7 d(T 3)时抽取外周静脉血样，采用ELISA法检测血清二胺氧化酶(DAO)、D-乳酸(D-LAC)、细菌内毒素(BT)、TNF-α及IL-6浓度。记录术后并发症发生情况、肛门排气时间及住院时间。 结果:与R组比较，D组T 1，2时血清DAO、D-LAC、BT、TNF-α及IL-6浓度降低，肛门排气时间及住院时间缩短，需呼吸循环支持发生率和并发症总发生率降低( P<0.05)。 结论:右美托咪定复合麻醉对急性肠梗阻患者肠道屏障功能有一定保护作用。

abstractsObjective:To evaluate the effect of dexmedetomidine-based anesthesia on intestinal barrier function in the patients with acute intestinal obstruction.Methods:Ninety-four patients with acute intestinal barrier obstruction, aged 33-81 yr, weighing 48-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=47 each) using a random number table method: routine anesthesia group (group R) and dexmedetomidine-based anesthesia group (group D). In group D, dexmedetomidine was intravenously injected in a loading dose of 1 μg/kg at 15 min before induction of general anesthesia followed by an infusion of 0.5 μg·kg -1·h -1 until 30 min before the end of operation.Before infusing the loading dose of dexmedetomidine, at 1 day after surgery, at 3 days after surgery, and at 7 days after surgery, peripheral venous blood samples were collected to measure the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6.The occurrence of postoperative complications, anal exhaust time and average length of hospital stay were recorded. Results:Compared with group R, the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6 were significantly decreased at 1 and 3 days after surgery, anal exhaust time and average length of hospital stay were shortened, and the requirement for respiratory cycle support and total incidence of complications were decreased in group D ( P<0.05). Conclusion:Dexmedetomidine-based anesthesia can improve intestinal barrier function to a certain extent in patients with acute intestinal obstruction.