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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2016, Vol. 03 ›› Issue (04) : 155 -158. doi: 10.3877/cma.j.issn.1674-6899.2016.04.004

所属专题： 文献；

论著

右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响
杨毅1, 李学斌1, 徐桂萍1,†()   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院麻醉科
  • 收稿日期:2016-08-20 出版日期:2016-11-15
  • 通信作者: 徐桂萍

Effect of dexmedetomidine on perioperative immunologic function in treatment of hiatal hernia combined with gastroesophageal reflux disease undergoing laparoscopic operation

Yi Yang1, Xuebin Li1, Guiping Xu1,†()   

  1. 1. Department of Anesthesiology, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
  • Received:2016-08-20 Published:2016-11-15
  • Corresponding author: Guiping Xu
  • About author:
    Corresponding author: Xu Guiping, Email:
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杨毅, 李学斌, 徐桂萍. 右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响[J/OL]. 中华胃食管反流病电子杂志, 2016, 03(04): 155-158.

Yi Yang, Xuebin Li, Guiping Xu. Effect of dexmedetomidine on perioperative immunologic function in treatment of hiatal hernia combined with gastroesophageal reflux disease undergoing laparoscopic operation[J/OL]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2016, 03(04): 155-158.

目的

探讨右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响。

方法

选取2014年3月至2016年3月，新疆维吾尔自治区人民医院收治并择期行全麻下腹腔镜手术治疗的食管裂孔疝合并胃食管反流病患者180例为研究对象，采用随机数字表法将上述研究对象分为观察组和对照组，各90例。观察组在麻醉诱导前30 min给予负荷剂量的右美托咪定(0.5 μg/kg)，手术开始后以维持剂量0.3 μg/(kg·h)的速率泵人至手术结束；而对照组患者给予等负荷量和维持剂量的生理盐水。分别在不同时间点，即麻醉前(T1)、患者手术结束时(T2)、患者手术结束后30 min(T3)及患者手术结束后24 h(T4)使用流式细胞仪检测T淋巴细胞亚群和NK细胞水平并记录不良反应发生情况。

结果

2组患者在T1时点免疫功能指标如血清CD3＋、CD4＋、CD8＋、CD4＋/CD8＋和NK细胞水平比较，差异无统计学意义(P>0.05)；与T1时点比较，2组患者在T2、T3和T4时点时CD3＋、CD4＋、CD4＋/CD8＋水平均显著降低；与对照组比较，观察组患者T2、T3和T4时CD3＋、CD4＋、CD4＋/CD8＋和NK水平明显升高(P<0.05)。与对照组比较，观察组心动过速、高血压发生情况有所降低(P<0.05)，而心动过缓、低血压及苏醒延迟发生情况有所升高(P<0.05)；寒颤、呼吸抑制的发生情况，2组比较，差异无统计学意义。

结论

右美托咪定辅助麻醉可显著改善行腹腔镜下治疗食管裂孔疝合并胃食管反流病患者围术期机体免疫功能，值得临床推广。

关键词: 免疫, 胃食管反流, 腹腔镜, 疝，食管裂孔
Objective

To investigate the effect of dexmedetomidine on perioperative immune function in patients with hiatal hernia combined with gastroesophageal reflux disease by laparoscopic operation.

Methods

A total of 180 patients with hiatal hernia combined with gastroesophageal reflux disease undergoing operation by laparoscopy in our hospital from March 2014 to March 2016 were enrolled in the study.These patients were divided into observation group(90 cases)and control group(90 cases)by random digital table.A loading dose of dexmedetomidine with 0.5 μg/kg was givenat 30 min before induction of anesthesia, and after operation was started, dexmedetomidine was infused at 0.3 μg/(kg·h)until the end of operation in observation group, and the equal loading dose and rateof normal saline was given in control group.The T lymohocyte subpopulations and NK cell levels in plasma were measured by flow cytometry before anesthesia(T1), and after operation(T2), 30 minutes after operation(T3)and 24 hours after operation(T4). The adverse reactions during operation were recorded.

Results

There were no significant differences in the levels of CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ and NK cells between two groups at T1(P>0.05); Compared with T1, the levels of CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ were significantly decreased in both groups at T2, T3 and T4; Compared with control group, the levels of CD3+ , CD4+ , CD4+ /CD8+ and NK cells in peripheral blood were significant higher at T2, T3 and T4(P<0.05). Compared with control group, the incidence of tachycardia and hypertension was decreased and bradycardia, hypotension and wake up delay increased(P<0.05); The incidence of chills and respiratory depression was compared in both groups, the difference was no statistically significant.

Conclusion

Dexmedetomidine assisting anesthesia can significantly improve perioperative immune function in patients undergoing operation by laparoscopy for hiatal hernia combined with gastroesophageal reflux disease, which is worthy of clinical promotion.

Key words: Immunity, Gastroesophageal reflux, Laparoscopic, Hernia, Hiatal
表1 2组患者一般临床资料比较
组别 例数 性别(例) 平均年龄[岁，(±s)] 食管裂孔疝类型(例) 手术方式(例)
男 女 滑动型 食管旁型 混合型 巨大型 Nissen式 Toupet式 Dor式
对照组 105 45 45 50.9±7.4 49 20 16 5 55 16 19
观察组 105 46 44 49.7±6.3 51 18 17 4 56 15 19
t值 ? 0.698 0.757 0.945 0.821
P值 ? 1.352 1.201 0.711 0.809
表2 2组患者各时间点血清T淋巴细胞亚群和NK细胞水平比较(±s)
指标 组别 T1 T2 T3 T4
CD3＋(%) 对照组 61±3 49±3* 50±4* 53±3*
? 观察组 63±3 54±2*# 57±3*# 58±3*#
CD4＋(%) 对照组 36±4 24±4* 26±3* 27±4*
? 观察组 37±3 30±3*# 31±3*# 32±3*#
CD8＋(%) 对照组 27±4 28±3 28±3 29±3
? 观察组 28±3 27±3 28±3 28±4
CD4＋/CD8＋ 对照组 1.38±0.20 0.83±0.15* 0.88±0.21* 0.96±0.16*
? 观察组 1.35±0.23 1.07±0.18*# 1.01±0.19*# 1.11±0.18*#
NK(%) 对照组 21±3 13±2* 15±3* 15±4*
? 观察组 21±2 18±3# 20±2# 21±3#
表3 2组患者不良反应发生情况(例)
组别 例数 心动过速 心动过缓 高血压 低血压 呼吸抑制 寒颤 苏醒延迟
对照组 90 20 2 20 6 1 4 5
观察组 90 3 7 5 9 0 3 9
t值 ? 9.032 7.135 8.425 6.256 0.906 0.793 7.312
P值 ? 0.011 0.034 0.016 0.040 0.768 0.968 0.032
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