目的 分析右美托咪定(Dex)联合依托咪酯(ET)靶控输注对胃癌根治术(ROCS)患者应激激素及T淋巴细胞亚群的影响.方法 将98例ROCS患者根据随机数字表法分为A组(诱导麻醉中用靶控输注ET,49例)和B组(A组的基础上联合Dex,49例),观察至术后72 h.比较两组应激激素、T淋巴细胞亚群、简易智力状态检查量表(MMSE)评分、认知功能障碍发生率、术中麻醉药物用量及术后苏醒情况.结果 两组入室时、麻醉诱导后、拔管时心率(HR)、收缩压(SBP)、舒张压(DBP)先升高后降低,且B组麻醉诱导后、拔管时低于A组,差异有统计学意义(P<0.05).两组术后 24 h血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、外周血CD8+高于入室时,但B组低于A组,差异有统计学意义(P<0.05),外周血CD3+、CD4+及CD4+/CD8+低于入室时,但B组高于A组,差异有统计学意义(P<0.05).两组入室时及术后24、72 h MMSE评分先降低后升高,且B组术后24、72 h MMSE评分高于A组,差异有统计学意义(P<0.05);术后观察期间,B组认知功能障碍发生率低于A组,术中丙泊酚、舒芬太尼用量、术后拔管呛咳、躁动发生率低于A组,差异有统计学意义(P<0.05).结论 Dex联合依托咪酯靶控输注可有效稳定ROCS患者血流动力学,减少术中麻醉药物用量,缓解机体应激,有助于免疫功能的维持并改善术后认知功能,安全性高.
Effects of target?controlled infusion of dexmedetomidine combined with etomidate on stress hormones and T lymphocyte subsets in patients undergoing radical gastrectomy
Objective To analyze the effects of dexmedetomidine(Dex)combined with etomidate(ET)target⁃controlled infusion on stress hormones and T lymphocyte subsets in patients undergoing radical gas⁃trectomy(ROCS).Methods 98 patients who underwent radical gastrectomy were divided into group A(target⁃controlled infusion of etomidate during induction anesthesia,49 cases)and the group B(combined Dex based on the group A,49 cases)by random number table method.All patients were observed until 72 h after opera⁃tion.The levels of stress hormones,T lymphocyte subsets,mini⁃mental state examination(MMSE)scores,the incidence of cognitive dysfunction,the dosage of anesthetic drugs during operation and postoperative recovery were compared between the two groups.Results The heart rate(HR),systolic blood pressure(SBP)and dia⁃stolic blood pressure(DBP)of both groups increased first and then decreased at the time of entering the room,after anesthesia induction and extubation.The group B were lower than those of the group A after anesthesia in⁃duction and extubation(P<0.05).The levels of serum cortisol(Cor),adrenocorticotropic hormone(ACTH),norepinephrine(NE)and peripheral blood CD8+at 24 h after operation in the two groups were higher than those at admission,but those in the group B were lower than those in the group A(P<0.05).The levels of CD3+,CD4+and CD4+/CD8+were lower than those at admission,but those in the group B were higher than those in the group A(P<0.05).The scores of MMSE of the two groups decreased first and then increased at the time of ad⁃mission and at 24 and 72 h after operation showed.The scores of MMSE of the group B at 24 and 72 h after op⁃eration were higher than those of the group A(P<0.05).During the postoperative observation,the incidence of cognitive dysfunction,the dosage of propofol and sufentanil,and the incidence of cough and restlessness after extubation was lower than in the group A(P<0.05).Conclusion Dex combined with etomidate target⁃con⁃trolled infusion can effectively stabilize the hemodynamics of patients undergoing radical gastrectomy for gastric cancer.This combination reduces the dosage of anesthetic drugs during the operation,relieves the stress on the body,helps maintain immune function,improves postoperative cognitive function,and is highly safe.
万方数据
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