摘要目的 探讨右美托咪定对妇科腹腔镜手术患者血流动力学、免疫功能及炎性因子的影响.方法 选择86例行妇科腹腔镜手术患者,按随机对照表法分为观察组和对照组,各43例.观察组行常规全麻,并静脉泵入右美托咪定;对照组行常规全麻,并静脉泵入0.9%氯化钠注射液,观察比较不同时段两组患者血流动力学、炎性因子及免疫功能变化.结果 观察组和对照组患者插管时心率(HR)均较诱导前显著升高(t=-3.257、-5.019,均P<0.05),气腹15 min、气腹30 min时均较诱导前显著降低(气腹15 min:t=2.111、-5.019,气腹30 min:t=3.078、3.926,均P<0.05),但观察组HR变化幅度明显较对照组小(插管时:t=-2.078;气腹15 min:t=2.105,气腹30 min:t=1.993,均P<0.05),观察组插管时MAP与诱导前差异无统计学意义(t=1.893,P>0.05),对照组插管时MAP较诱导前显著升高(t=-2.122,P<0.05),且插管时观察组MAP明显低于对照组MAP(t=-3.477,P<0.05),术后24 h,两组患者HR、MAP基本恢复,与诱导前差异均无统计学意义(HR:t=0.474、0.233,MAP:t=0.853、-0.273,均P>0.05);两组患者术毕、术后24 h时C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均较诱导前显著升高(CRP:t=-9.974、-16.872,IL-6:t=-7.284、-11.449,均P<0.05),且对照组升高更显著(CRP:t=-7.509,IL-6:t=-4.744,均P<0.05);观察组患者术毕时、术后24 h CD+3、CD+4、CD+4/CD+8、NK均与治疗前差异均无统计学意义(t=0.154、1.204、1.546、-0.289,均P>0.05),对照组患者术毕时CD+3、CD+4、CD+4/CD+8、NK均较诱导前显著降低(t=11.514、10.317、9.180、6.815,均P<0.05),且两组患者术毕时CD+3、CD+4、CD+4/CD+8、NK差异均有统计学意义(t=10.232、10.298、7.728、4.900,均P<0.05),对照组患者术后24 h CD+3、CD+4、CD+4/CD+8基本恢复,但NK仍较治疗前显著降低(t=4.362,P<0.05).结论 对妇科腹腔镜手术患者应用右美托咪定血流动力学更稳定,可减少免疫功能损伤,减少炎性反应.

abstractsObjective To investigate the effect of dexmedetomidine hydrochloride on hemodynamics,immune function and inflammatory factors in patients with gynecological laparoscopic operation.Methods According to the random comparison table,86 elderly patients with gynecological laparoscopic operation were divided into observation group(43cases) and control group(43cases).The observation group received conventional general anesthesia,and intravenously pumped with dexmedetomidine hydrochloride.The the control group received conventional general anesthesia,and intravenously pumped with normal saline.The changes of hemodynamics,immune function and inflammatory factors were observed and compared in different periods in the two groups.Results Compared with before induction,the level of HR increased significantly at intubation(t=-3.257,-5.019,all P<0.05),the level of HR decreased significantly at 15 min and 30 min after pneumoperitoneum in the two groups(15 min after pneumoperitoneum:t=2.111,-5.019;15 min after pneumoperitoneum:t=3.078,3.926,all P<0.05),but the changes of the observation group variation were significant smaller(at intubation:t=-2.078;15 min after pneumoperitoneum:t=2.105;30 min after pneumoperitoneum:t=1.993,all P<0.05),the level of MAP had no significant difference at intubation in the observation group(t=1.893,P>0.05),the level of MAP increased significantly at intubation in control group(t=-2.122,P<0.05),and there was significant difference at intubation in the two groups(t=-3.477,P<0.05).Compared with before induction,the levels of HR and MAP recovered in the two groups,there were no statistically significant difference at 24 h after operation(HR:t=0.474,0.233;MAP:t=0.853,-0.273,all P>0.05);Compared with before induction,the levels of CRP and IL-6 increased significantly at after operation and 24 h after operation in the two groups(CRP:t=-9.974,-16.872;IL-6:t=-7.284,-11.449,all P<0.05),and the levels of CRP and IL-6 increased more significantly in the control group(CRP:t=-7.509;IL-6:t=-4.744,all P<0.05);Compared with before induction,the levels of CD+3,CD+4,CD+4/CD+8 and NK had no statistically significant differences at after operation and 24 h after operation in the observation group(t=0.154,1.204,1.546,-0.289,all P>0.05),the levels of CD+3,CD+4,CD+4/CD+8 and NK decreased significantly after operation in the control group(t=11.514,10.317,9.180,6.815,all P<0.05),there were statistically significant differences after operation in the two groups(t=10.232,10.298,7.728,4.900,all P<0.05),and the level of NK decreased significantly at 24h after operation in the control group(t=4.362,P<0.05).Conclusion Dexmedetomidine hydrochloride can keep hemodynamics stability,reduce immune function damage and inflammation.