右美托咪定辅助静吸复合麻醉对进展期胃癌患者术后机体氧化损伤及血清Thl/Th2、皮质醇水平的影响
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摘要
目的探讨右美托咪定辅助静吸复合麻醉对进展期胃癌患者术后机体氧化损伤及血清Thl/Th2、皮质醇(Cor)水平变化的影响。方法前瞻性选取2015年4月至2017年7月孝感市中心医院74例进展期胃癌患者,随机数字表法分为对照组(n=37)与研究组(n=37)。对照组采取静吸复合麻醉,研究组采取右美托咪定辅助静吸复合麻醉。分别于不同时间段[麻醉诱导前(T0)、手术开始后30 min(T1)、术后30 min(T2)]对比两组皮质醇(Cor)、氧化损伤指标[超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)、丙二醛(MDA)]、Thl/Th2指标[干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)、IFN-γ/IL-4]水平、七氟醚吸入浓度及不良反应发生率。结果 T1、T2时期两组血清Cor水平较T0时期增高,但研究组较对照组低(P <0. 05);术后两组血清SOD、GSH水平较术前降低,MDA水平较术前增高,但研究组血清SOD、GSH水平较对照组高,MDA水平较对照组低(P <0. 05);术后两组血清IFN-γ、IFN-γ/IL-4较术前增高,IL-4较术前降低,且研究组IFN-γ、IFN-γ/IL-4较对照组高,IL-4较对照组低(P <0. 05); T0时期两组七氟醚吸入浓度比较,差异无统计学意义(P> 0. 05),T1、T2时期研究组七氟醚吸入浓度较对照组低(P <0. 05);研究组不良反应发生率(10. 81%)较对照组(29. 73%)低(P <0. 05)。结论右美托咪定辅助静吸复合麻醉利于减轻应激反应及氧化损伤程度,降低七氟醚吸入浓度,并改善术后免疫抑制状态,利于机体免疫功能恢复,减少不良反应。
Objective To investigate the effects of dexmedetomidine combined with intravenous inhalation compond anesthesia on oxidative damage and serum levels of Thl/Th2 and cortisol( Cor) in patients with advanced gastric cancer. Methods 74 patients with advanced gastric cancer in our hospital from April 2015 to July 2017 were randomly divided into the control group( n = 37) and the study group( n = 37). The control group received intravenous inhalation compond anesthesia,and the study group received intravenous inhalation compond anesthesia assisted by dexmedetomidine. In different period of time [before the induction of anesthesia( T0),30 min after the start of operation( T1),30 min after operation( T2) ],cortisol( Cor),oxidative damage index [superoxide dismutase( SOD),glutathione( GSH),malondialdehyde( MDA) ],Thl/Th2 index [interferon γ( IFN-γ),interleukin-4( IL-4),IFN-γ/IL-4] level,sevoflurane concentration and the incidence of adverse reactions between two groups were compared. Results The serum Cor levels of the two groups in the T1 and T2 periods were higher than those in the T0 phase,but the study group was lower than the control group( P < 0. 05). The levels of serum SOD and GSH in the two groups were lower than those before the operation,and the level of MDA was higher than that before the operation,but the serum levels of SOD and GSH in the study group were higher than those of the control group,and the level of MDA was lower than that of the control group( P < 0. 05). The levels of serum IFN-γ,IFN-γ and/IL-4 in the two groups were higher than those before operation,and IL-4 was lower than that before the operation,and the levels of IFN-γ,IFN-γ and/IL-4 of the study group were higher than that of the control group,and IL-4 was lower than that of the control group( P < 0. 05). There was insignificant difference in the inhaled concentration of sevoflurane between the two groups in T0 period( P >0. 05). The inhalation concentration of sevoflurane in the study group was lower than that in the control group during the period of T1 and T2( P< 0. 05). The incidence of adverse reactions in the study group( 10. 81%) was lower than that in the control group( 29. 73%). Conclusion Dexmedetomidine combined with intravenous inhalation compond anesthesia can reduce the stress response and oxidative damage,reduce the concentration of sevoflurane inhalation,and improve the immunosuppressive status after surgery,restore immune function and reduce adverse reactions.
Objective To investigate the effects of dexmedetomidine combined with intravenous inhalation compond anesthesia on oxidative damage and serum levels of Thl/Th2 and cortisol( Cor) in patients with advanced gastric cancer. Methods 74 patients with advanced gastric cancer in our hospital from April 2015 to July 2017 were randomly divided into the control group( n = 37) and the study group( n = 37). The control group received intravenous inhalation compond anesthesia,and the study group received intravenous inhalation compond anesthesia assisted by dexmedetomidine. In different period of time [before the induction of anesthesia( T0),30 min after the start of operation( T1),30 min after operation( T2) ],cortisol( Cor),oxidative damage index [superoxide dismutase( SOD),glutathione( GSH),malondialdehyde( MDA) ],Thl/Th2 index [interferon γ( IFN-γ),interleukin-4( IL-4),IFN-γ/IL-4] level,sevoflurane concentration and the incidence of adverse reactions between two groups were compared. Results The serum Cor levels of the two groups in the T1 and T2 periods were higher than those in the T0 phase,but the study group was lower than the control group( P < 0. 05). The levels of serum SOD and GSH in the two groups were lower than those before the operation,and the level of MDA was higher than that before the operation,but the serum levels of SOD and GSH in the study group were higher than those of the control group,and the level of MDA was lower than that of the control group( P < 0. 05). The levels of serum IFN-γ,IFN-γ and/IL-4 in the two groups were higher than those before operation,and IL-4 was lower than that before the operation,and the levels of IFN-γ,IFN-γ and/IL-4 of the study group were higher than that of the control group,and IL-4 was lower than that of the control group( P < 0. 05). There was insignificant difference in the inhaled concentration of sevoflurane between the two groups in T0 period( P >0. 05). The inhalation concentration of sevoflurane in the study group was lower than that in the control group during the period of T1 and T2( P< 0. 05). The incidence of adverse reactions in the study group( 10. 81%) was lower than that in the control group( 29. 73%). Conclusion Dexmedetomidine combined with intravenous inhalation compond anesthesia can reduce the stress response and oxidative damage,reduce the concentration of sevoflurane inhalation,and improve the immunosuppressive status after surgery,restore immune function and reduce adverse reactions.
引文
[1]Kim YS,Kang SH,Song KY,et al.The immunomodulatory role of esmolol in patients undergoing laparoscopic gastrectomy due to gastric cancer[J].Anaesthesia,2013,68(9):924-930.
[2]贺桂文,王才英.右美托咪啶对胃癌根治术后吗啡静脉自控镇痛患者T免疫细胞亚群的临床价值[J].检验医学与临床,2016,13(3):399-401.
[3]Jiang CG,Xu Y,Wang ZN,et al.Clinicopathological analysis and prognostic significance of peritoneal cytology in Chinese patients with advanced gastric cancer[J].Anz Journal of Surgery,2011,81(9):608-613.
[4]宿明艳,张晓坤,王喆妍,等.右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶和血糖及丙二醛浓度的影响[J].临床麻醉学杂志,2016,32(12):1162-1164.
[5]Kun L,Tang L,Wang J,et al.Effect of Combined General/Epidural Anesthesia on Postoperative NK Cell Activity and Cytokine Response in Gastric Cancer Patients Undergoing Radical Resection[J].Hepatogastroenterology,2014,61(132):1142-1147.
[6]刘国奕.右美托咪定对老年胃癌根治术患者T细胞亚群及自然杀伤细胞的影响[J].中国老年学杂志,2015,35(8):2057-2059.
[7]Cho SS,P ark YD,Noh JH,et al.Anesthetic experience of methemoglobinemia detected during general anesthesia for gastrectomy of advanced gastric cancer-A case report[J].Korean J Anesthesiol,2010,59(5):340-343.
[8]刘显珍,褚海辰,高洁,等.右美托咪定预防胃癌根治术病人术后躁动的临床观察[J].现代生物医学进展,2013,13(20):3958-3961.
[9]高慧,姬乐,王敏,等.右美托咪定对胃癌手术患者免疫状况的影响[J].癌症进展,2016,14(8):774-776.
[10]Zhang L,Chen C,Wang L,et al.Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer[J].Int J Clin Exp Med,2015,8(10):19412-19417.
[11]王静瑞.盐酸右美托咪定对胃癌根治术患者围术期应激反应的影响[J].中国老年学杂志,2014,34(5):1261-1262.
[12]王梅芳,濮建峰,黄迅.右美托咪定对老年胃癌根治术全麻诱导期及恢复期心血管反应的影响[J].实用临床医药杂志,2015,19(21):160-161.
[13]王红仙,张野,李云,等.右美托咪定对胃癌根治术中瑞芬太尼复合丙泊酚全麻药量及麻醉效果的影响[J].安徽医科大学学报,2014,49(1):88-91.
[14]李军利,艾艳秋.右美托咪定对老年胃癌根治术患者呼吸功能的影响[J].中国实用医刊,2016,43(20):40-43.
[15]Jakob SM,Ruokonen E,Grounds RM,et al.Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation[J].JAMA,2012,307(11):1151.
[16]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:360-364.
[17]Ogata K,Yanai M,Kuriyama K,et al.Double Endoscopic Intraluminal Operation(DEILO)for Early Gastric Cancer:Outcome of Novel Procedure for Endoscopic Submucosal Dissection[J].Anticancer Res,2017,37(1):343-347.
[18]朱志德,李经毅,朱文斌,等.右美托咪定对腹腔镜辅助胃癌根治术患者炎症因子的影响[J].肿瘤药学,2017,7(4):455-459.
[19]赵迪,瞿琬林,陈锋.右美托咪定联合罗哌卡因股神经阻滞用于膝关节镜术后镇痛的临床研究[J].临床和实验医学杂志,2017,16(21):2179-2180.
[20]徐海军,王荣国,刘倩.右美托咪定辅助全身麻醉在胃癌根治手术患者中的应用[J].实用癌症杂志,2014,29(11):1455-1457.
[21]Shang Y,Long XH,Gao GJ,et al.Dosage study of dexmedetomidineassisted sufentanil administration on vein analgesia after gastric cancer surgery[J].J Clin Anesthesiology,2013,29(3):247-250.
[22]秦成伟,吴吉智.右美托咪定对腹腔镜下胃癌手术七氟醚用量的影响以及血清炎症因子含量检测[J].中国现代医学杂志,2014,24(34):38-41.
[23]Takimoto K,Ueda T,Shimamoto F,et al.Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer[J].Dig Endosc,2011,23(2):176-181.
[24]江华勇,陈忠华,蒋宗明,等.硬膜外阻滞对老年腹腔镜胃癌根治术患者围术期Th1/Th2平衡的影响[J].浙江医学,2015,37(10):864-866.
[25]高峰,吴震.不同麻醉方式对胃癌根治术患者Th1/Th2平衡的影响[J].华中科技大学学报(医学版),2014,43(4):405-408.
[26]陈忠华,蒋宗明,楼静芝,等.帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th1/Th2平衡的影响[J].中国临床药理学与治疗学,2010,15(6):686-690.
[27]徐兴国,陈红生,崔松勤,等.右美托咪定对胃癌根治术患者围术期白细胞介素-6、皮质醇及T淋巴细胞亚群的影响[J].临床麻醉学杂志,2012,28(5):480-482.
[2]贺桂文,王才英.右美托咪啶对胃癌根治术后吗啡静脉自控镇痛患者T免疫细胞亚群的临床价值[J].检验医学与临床,2016,13(3):399-401.
[3]Jiang CG,Xu Y,Wang ZN,et al.Clinicopathological analysis and prognostic significance of peritoneal cytology in Chinese patients with advanced gastric cancer[J].Anz Journal of Surgery,2011,81(9):608-613.
[4]宿明艳,张晓坤,王喆妍,等.右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶和血糖及丙二醛浓度的影响[J].临床麻醉学杂志,2016,32(12):1162-1164.
[5]Kun L,Tang L,Wang J,et al.Effect of Combined General/Epidural Anesthesia on Postoperative NK Cell Activity and Cytokine Response in Gastric Cancer Patients Undergoing Radical Resection[J].Hepatogastroenterology,2014,61(132):1142-1147.
[6]刘国奕.右美托咪定对老年胃癌根治术患者T细胞亚群及自然杀伤细胞的影响[J].中国老年学杂志,2015,35(8):2057-2059.
[7]Cho SS,P ark YD,Noh JH,et al.Anesthetic experience of methemoglobinemia detected during general anesthesia for gastrectomy of advanced gastric cancer-A case report[J].Korean J Anesthesiol,2010,59(5):340-343.
[8]刘显珍,褚海辰,高洁,等.右美托咪定预防胃癌根治术病人术后躁动的临床观察[J].现代生物医学进展,2013,13(20):3958-3961.
[9]高慧,姬乐,王敏,等.右美托咪定对胃癌手术患者免疫状况的影响[J].癌症进展,2016,14(8):774-776.
[10]Zhang L,Chen C,Wang L,et al.Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer[J].Int J Clin Exp Med,2015,8(10):19412-19417.
[11]王静瑞.盐酸右美托咪定对胃癌根治术患者围术期应激反应的影响[J].中国老年学杂志,2014,34(5):1261-1262.
[12]王梅芳,濮建峰,黄迅.右美托咪定对老年胃癌根治术全麻诱导期及恢复期心血管反应的影响[J].实用临床医药杂志,2015,19(21):160-161.
[13]王红仙,张野,李云,等.右美托咪定对胃癌根治术中瑞芬太尼复合丙泊酚全麻药量及麻醉效果的影响[J].安徽医科大学学报,2014,49(1):88-91.
[14]李军利,艾艳秋.右美托咪定对老年胃癌根治术患者呼吸功能的影响[J].中国实用医刊,2016,43(20):40-43.
[15]Jakob SM,Ruokonen E,Grounds RM,et al.Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation[J].JAMA,2012,307(11):1151.
[16]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:360-364.
[17]Ogata K,Yanai M,Kuriyama K,et al.Double Endoscopic Intraluminal Operation(DEILO)for Early Gastric Cancer:Outcome of Novel Procedure for Endoscopic Submucosal Dissection[J].Anticancer Res,2017,37(1):343-347.
[18]朱志德,李经毅,朱文斌,等.右美托咪定对腹腔镜辅助胃癌根治术患者炎症因子的影响[J].肿瘤药学,2017,7(4):455-459.
[19]赵迪,瞿琬林,陈锋.右美托咪定联合罗哌卡因股神经阻滞用于膝关节镜术后镇痛的临床研究[J].临床和实验医学杂志,2017,16(21):2179-2180.
[20]徐海军,王荣国,刘倩.右美托咪定辅助全身麻醉在胃癌根治手术患者中的应用[J].实用癌症杂志,2014,29(11):1455-1457.
[21]Shang Y,Long XH,Gao GJ,et al.Dosage study of dexmedetomidineassisted sufentanil administration on vein analgesia after gastric cancer surgery[J].J Clin Anesthesiology,2013,29(3):247-250.
[22]秦成伟,吴吉智.右美托咪定对腹腔镜下胃癌手术七氟醚用量的影响以及血清炎症因子含量检测[J].中国现代医学杂志,2014,24(34):38-41.
[23]Takimoto K,Ueda T,Shimamoto F,et al.Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer[J].Dig Endosc,2011,23(2):176-181.
[24]江华勇,陈忠华,蒋宗明,等.硬膜外阻滞对老年腹腔镜胃癌根治术患者围术期Th1/Th2平衡的影响[J].浙江医学,2015,37(10):864-866.
[25]高峰,吴震.不同麻醉方式对胃癌根治术患者Th1/Th2平衡的影响[J].华中科技大学学报(医学版),2014,43(4):405-408.
[26]陈忠华,蒋宗明,楼静芝,等.帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th1/Th2平衡的影响[J].中国临床药理学与治疗学,2010,15(6):686-690.
[27]徐兴国,陈红生,崔松勤,等.右美托咪定对胃癌根治术患者围术期白细胞介素-6、皮质醇及T淋巴细胞亚群的影响[J].临床麻醉学杂志,2012,28(5):480-482.