子宫切除术前给予右美托咪定对患者应激和免疫功能的影响

doi:10.13481/j.1671-587x.20150628

摘要/Abstract

摘要：

目的:探讨右美托咪定对子宫切除术患者应激及免疫功能的影响,旨在为临床麻醉用药提供依据。方法:选取子宫肌瘤且需行择期子宫切除术患者60例,ASA Ⅰ-Ⅱ级,依据预输注药物不同分为观察组和对照组,每组30例,观察组患者麻醉前给予负荷剂量右美托咪定静脉泵注,剂量1 μg·kg^-1,浓度4 mg·L^-1,泵注时间10 min,对照组患者给予等量生理盐水泵注。2组均在泵注10 min后开始诱导,麻醉中2组患者均使用七氟醚和芬太尼维持;2组患者于入室前(T0)、手术2 h(T1)和术后拔管时(T2)采血,检测血清皮质醇(COR)和白细胞介素2(IL-2)浓度,并检测血浆T 淋巴细胞亚群和 NK 细胞水平。结果:2组患者T0时血清COR和IL-2浓度比较差异无统计学意义(P>0.05);2组患者T2时COR浓度明显高于T0时(P<0.05);观察组T2时COR浓度明显低于对照组(P<0.05);随手术时间延长2组患者血清IL-2浓度呈下降趋势,观察组T2时血清IL-2浓度明显高于对照组(P<0.05);2组患者T0时CD³⁺、CD⁴⁺、CD⁸⁺、CD⁴⁺/ CD⁸⁺和NK水平比较差异无统计学意义(P>0.05);2组患者各时间点CD⁸⁺水平比较差异均无统计学意义(P>0.05);对照组患者T1和T2时CD³⁺、CD⁴⁺、CD⁴⁺/ CD⁸⁺及NK水平均明显低于T0时(P<0.05);观察组T2时CD³⁺、CD⁴⁺、CD⁴⁺/ CD⁸⁺和NK水平均明显高于对照组(P<0.05)。结论:右美托咪定辅助麻醉可减轻患者术后应激反应,降低麻醉及手术创伤对机体细胞免疫功能的影响,利于患者术后康复。

关键词: 子宫切除术, 右美托咪定, 皮质醇, 白细胞介素2, T淋巴细胞亚群

Abstract:

Objective To explore the effect of dexmedetomidine on the stress and immunologic function in the patients undergoing uterectomy,and to provide an evidence for the medication in clinical anesthesia. Methods A total of 60 hysteromyoma patients who needed uterectomy were selected. All the patients were in ASAⅠ-Ⅱlevel.The patients were divided into observation group (n=30) and control group (n=30) according to administration of different types of drugs.Before anesthesia,the patients in observation group were given dexmedetomidine (l μg·kg^-1) with a concentration of 4 g·L^-1 for 10 min,while the patients in control group were given equal normal saline.The induction was performed 10 min after infusion pump.Sevoflurane and fentanyl were used for maintaining during the anesthesia.The blood samples of the patients in two groups before entering the operation room (T0),2h after operation (T1),and extubation after operation (T2) were collected.The serum cortisol (COR) and interleukin-2 (IL-2) concentrations,plasma T lymphocyte subpopulations and NK levels were detected. Results The differences of COR and IL-2 concentrations at T0 between two groups were not statistically significant (P>0.05).The COR concentrations at T2 in two groups were significantly higher than those at T0 (P<0.05).The COR concentration at T2 in observation group was significantly lower than that in control group (P<0.05).The serum IL-2 concentration was gradually decreased with the prolongation of time observation in two groups.The serum IL-2 concentration in observation group was significantly higher than that in control group (P<0.05).The differences of CD³⁺,CD⁴⁺,CD⁸⁺,CD⁴⁺/ CD⁸⁺,and NK levels at T0 between two groups were not statistically significant (P>0.05).The differences of CD⁸⁺ level in each time point between two groups were not statistically significant (P>0.05).The CD³⁺,CD⁴⁺,CD⁴⁺/ CD⁸⁺,and NK levels at T1 and T2 in control group were significantly lower than those at T0 (P<0.05).The CD³⁺,CD⁴⁺,CD⁴⁺/ CD⁸⁺,and NK levels at T2 in observation group were significantly higher than those in control group (P<0.05). Conclusion Dexmedetomidine assisting anesthesia can alleviate the postoperative stress reaction,and reduce the effect of anesthesia and operation wound on the cellular immune function.It is beneficial for the postoperative rehabilitation.

Key words: hysterectomy, dexmedetomidine, cortisol, interleukin-2, T lymphocyte subsets

中图分类号:

R614.2

刘红梅, 杨莉. 子宫切除术前给予右美托咪定对患者应激和免疫功能的影响[J]. 吉林大学学报(医学版), 2015, 41(06): 1245-1248.

LIU Hongmei, YANG Li. Influence of administration of dexmedetomidine before uterectomy in stress and immunologic function in patients[J]. Journal of Jilin University Medicine Edition, 2015, 41(06): 1245-1248.

参考文献

[1] 马立刚,王哲银.右美托咪定对腹腔镜子宫切除术患者循环及应激反应的影响 [J].广东医学,2011,32 (4):489-491.

[2] Boes S,Mahdi H,Khoury F,et al.Peripartum robotic-assisted laparoscopic hysterectomy after second-trimester pregnancy loss with placenta increta[J].Obstet Gynecol,2013,122 (2):440-444.

[3] Preslaski CR,Mueller SW,Wempe MF,et al.Stability of dexmedetomidine in polyvinyl chloride bags containing 0.9% sodium chloride injection [J].Am J Health Syst Pharm,2013,70 (15):1336-1341.

[4] 袁静,卢航青,郑康,等.右美托咪定对食管癌患者围术期免疫功能的影响 [J].中国老年学杂志,2013,33(1):59-61.

[5] 李爱梅,石翊飒,高瑞萍,等.不同剂量右美托咪定对脑膜瘤切除术患者术后认知功能的影响[J].临床麻醉学杂志,2013,29(7):655-668.

[6] Gill SE,Mills BB.Physician opinions regarding elective bilateral salpingectomy with hysterectomy and for sterilization[J].J Minim Invasive Gynecol,2013,20 (4):517-521.

[7] Aggarwal R,Bansal D,Bansal F,et al.Interleukin-5,interleukin-6,interleukin-8 and tumour necrosis factor-alpha levels obtained within 24h of admission do not predicthigh-risk infection in children with febrile neutropenia[J].Indian J Med Microbiol,2013,31 (3):226-229.

[8] Takehara Y,Satoh T,Nishizawa A,et al.Anti-tumoreffects of inactivated Sendai virus particles with an IL-2gene on angiosarcoma [J].Clin Immunol,2013,149(1):1-10.

[9] Park SH,Koo HJ,Sung YY,et al.The protective effect of Prunella vulgaris ethanol extract against vascular inflammation in TNF-α-stimulated human aortic smooth muscle cells[J].BMB Rep,2013,46 (7):352-357.

[10] 徐丽鲍,红光,张勇,等.右美托咪定对脓毒症大鼠早期和晚期炎症介质表达的影响[J].中国危重病急救医学,2012,24(9):562-564.

[11] 刘德昭,黄品婕,罗晨芳,等.脂微球化前列地尔对原位肝移植术患者肺损伤的影响[J].中华麻醉学杂志,2013,33(3):338-341.

[12] Jayaraman L,Sinha A,Punhani D.A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patientsundergoing bariatric surgery[J].J Anaesthesiol Clin Pharmacol,2013,29 (2):179-182.

[13] 许忠玲,范冰冰,郭华.右美托咪定对重症颅脑损伤患者围术期血浆 S 蛋白100B 及炎性细胞因子的影响 [J].临床麻醉学杂志,2012,28 (9):872-874.

[14] Parikh DA,Kolli SN,Karnik HS,et al.A prospective randomized double-blind study comparing dexmedetomidine vs.combination of midazolam-fentanyl for tympanoplasty surgeryunder monitored anesthesia care [J].J Anaesthesiol ClinPharmacol,2013,29 (2):173-178.

[15] Sakthivel KM,Guruvayoorappan C.Acacia ferruginea inhibitstumor progression by regulating inflammatory mediators-(TNF-α,iNOS,COX-2,IL-1β,IL-6,IFN-γ,IL-2,GM-CSF) and pro-angiogenic growth factor-VEGF [J].Asian Pac J Cancer Prev,2013,14 (6):3909-3919.

[16] 傅钢兰,王萌,徐晓莹,等.右美托咪定对乳腺癌根治术患者围术期T淋巴细胞亚群的影响[J].中华实验外科杂志,2014,31(5):944-946.

[17] 文先杰,梁桦,刘远英,等.右美托咪定对烫伤大鼠细胞免疫功能的影响[J].中华麻醉学杂志,2014,34(10):1267-1270.

[18] 王宏志,韩冲芳.右美托咪定应用于老年患者肺癌根治术围术期中免疫功能的影响[J].中国药物与临床,2014,14(9):1274-1275.