持续泵注盐酸右美托咪定对腹腔镜下结、直肠癌根治术患者围手术期动态肺顺应性和外周血中Toll 样受体2 和4 表达的影响

Effect of Dexmedetomidine on dynamic lung compliance and serum levels of TLR2 and TLR4 in patients receiving laparoscopic radical resection of colorectal cancer

摘要:

目的 评价盐酸右美托咪定对腹腔镜下结、直肠癌根治术患者围手术期动态肺顺应性（Cdyn）和外周血中Toll 样受体2（TLR-2）和（TLR-4）表达的影响。方法 选取2015 年7 月-2016 年6 月在中国医科大学附属盛京医院择期全身麻醉下行腹腔镜结、直肠癌根治术患者20 例，ASA 分级I 或Ⅱ级，年龄33 ～ 68 岁，体重指数（BMI）<30 kg/m2，采用随机数字表法分为两组：对照组（C 组10 例）和盐酸右美托咪定组（D 组10 例）。手术开始时，D 组盐酸右美托咪定以0.4 μg/（kg·h）的速率持续泵注至手术结束前30 min ；C 组静脉输注等容量生理盐水。记录麻醉诱导前（T0）、手术开始后30 min（T2）、60 min（T3）、90 min（T4）、拔管时（T6）和拔管后3 min（T7）的平均动脉压（MAP）和心率（HR）；记录插管后5 min（T1）、手术开始后30 min（T2）、60 min（T3）、90 min（T4）、手术结束前30 min（T5）、拔管时（T6）和拔管后3 min（T7）的气道压（Paw）和Cdyn；分别于麻醉诱导前（T0）、手术开始90 min（T4）、拔管后3 min（T7）和术后1 d（T8）采集上肢静脉血，检测外周血中TLR-2、TLR-4 及肿瘤坏死因子α（TNF-α）浓度。结果 与C 组比较，D 组瑞芬太尼用量减少（P <0.05）；与C 组比较，D 组T7 时刻MAP、HR 均下降（P <0.05）；与C 组比较，D 组T3、4 时Cdyn 升高（P <0.05）；与C 组比较，D 组T4、T7 及T8 时静脉血中TLR-2 和TLR-4 的浓度下调（P <0.05）；与C 组比较，D 组T4、T7 及T8 时血清中TNF-α 中的浓度降低（P <0.05）；两组睁眼时间、拔管时间差异均无统计学意义（P >0.05）。结论 持续泵注0.4μg/（kg·h）盐酸右美托咪定有助于稳定血流动力学，缓解炎症性应激反应，维持术中各项指标相对稳定, 对手术患者有一定的肺保护作用。

Abstract:

Objective To evaluate the effect of Dexmedetomidine on the lung compliance (Cdyn) and the expressions of Toll-like receptors 2 and 4 (TLR2 and TLR4) in the peripheral blood during perioperative period in the patients undergoing laproscopic colorectal cancer radical resection. Methods Twenty patients aged 33 to 68 years who underwent elective colorectal cancer radical resection under general anesthesia with ASA grade I or II and body mass index (BMI) <30 kg/m2 were enrolled. They were randomly divided into control group (group C) and Dexmedetomidine group (group D) with 10 in each group. In the group D, Dexmedetomidine was infused at a rate of 0.4 μg/(kg?h) from the beginning of surgery till 30 min before the end of surgery. The patients in the group C were given the same manipulation as in the group D except replacement of Dexmedetomidine by normal saline. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0), 30 min (T2), 60 min (T3) and 90 min (T4) after the beginning of surgery, at the time of extubation (T6), and 3 min after extubation (T7).Airway pressure (Paw) and Cdyn were recorded at 5 min after intubation (T1), T2-4, 30 min before the end of surgery(T5), T6 and T7, respectively. Venous blood was drawn to analyze the TLR2, TLR4 and TNF-α concentrations at T0,T4, T7 and the day after operation (T8), respectively. Results Compared with the group C, the dosage of Remifentanil in the group D was significantly decreased (P < 0.05). Compared with the group C, MAP and HR were decreased in the group D at T7 (P < 0.05); Cdyn increased in the group D at T3 and T4 (P < 0.05); serum TLR2 and TLR4 concentrations decreased in the group D at T4, T7 and T8 (P < 0.05); serum TNF-α concentration also decreased in the group D at T4, T7 and T8 (P < 0.05). Conclusions Continuous infusion of 0.4 μg/(kg?h) of Dexmedetomidine can help to maintain the hemodynamic stability, alleviate symptoms of inflammatory response induced by stress, so as to keep the vital signs stable during operation and has certain protective effect on patients.