摘要
目的:观察低剂量氯胺酮配合右美托咪定对宫颈癌根治术病人术后疲劳程度及疼痛介质、免疫功能状态的影响。方法:选取接受宫颈癌根治术病人150例,以简单随机化法分为观察组(n=75)和对照组(n=75)。2组均采取全麻,对照组麻醉诱导前静注0.5μg/kg右美托咪定,而后以0.5μg·kg^(-1)·h^(-1)输注至术毕前0.5 h,观察组在对照组基础上另于麻醉诱导前静注0.5 mg/kg氯胺酮。比较2组术中一般情况、手术不同时间点血流动力学指标、手术前后血清疼痛介质水平及免疫功能指标、术后视觉模拟量表(VAS)评分、手术前后疲劳量表-14(FS-14)及简易智力状态检测量表(MMSE)评分、麻醉不良反应情况。结果:2组手术时间、术中出血量、术中补液量差异无统计学意义(P>0.05);观察组切皮时、术中1 h时、术毕时时平均动脉压、心率水平均低于对照组(P<0.05~P<0.01);观察组术毕时、术后24 h、术后48 h时血清5-羟色胺、P物质、列腺素E_(2)水平均低于对照组(P<0.01);观察组术毕时、术后24 h及48 h时血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组(P<0.01);观察组术后24 h及48 h时VAS评分均低于对照组(P<0.01);观察组术后3 d、术后7 d的FS-14评分低于对照组,认知功能评分高于对照组(P<0.01);2组麻醉不良反应发生率间差异无统计学意义(P>0.05)。结论:低剂量氯胺酮配合右美托咪定应用于宫颈癌根治术病人,可稳定血流动力学,降低血清疼痛介质水平,减轻术后疼痛及疲劳程度,改善免疫功能状态及认知功能。
Objective:To observe the effects of low-dose ketamine combined with dexmedetomidine on the postoperative fatigue,pain mediators and immune function in patients treated with radical cervical cancer surgery.Methods:One hundred and fifty patients treated with radical cervical cancer surgery were selected,and divided into the observation group(n=75)and control group(n=75)by simple randomization method.Two groups were given general anesthesia.In the control group,the 0.5μg/kg dexmedetomidine was intravenously injected before induction of anesthesia,and then the 0.5μg·kg^(-1)·h^(-1) was infused until before 0.5 h of operation.The observation group was injected intravenously with 0.5 mg/kg ketamin before induction of anesthesia.The general conditions during the operation,hemodynamic indexes at different time points of operation,serum levels of pain mediator and immune function indexes before and after operation,visual analog scale(VAS)score after operation,fatigue scale-14(FS-14)and mini-mental state examination(MMSE)scores before and after operation and adverse reactions of anesthesia were compared between two groups.Results:The differences of the operation time,intraoperative blood loss,and intraoperative fluid supplement between two groups were not statistically significant(P>0.05).The average arterial pressure and heart rate in observation group at 1 hour during operation and at the end of operation were lower than those in control group(P<0.05 to P<0.01).The serum levels of serotonin,substance P,and serotonin E_(2) in observation group were lower than those in control group at the end of the operation,and after 24 h and 48 h of operation(P<0.01).The serum levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) in observation group at the end of the operation,and after 24 h and 48 h of operation were higher than those in the control group(P<0.01).The VAS scale scores in observation group were lower than those in control group after 24 h and 48 h of operation(P<0.01).After 3 d and 7 d of operation,the FS-14 scores in observation group were lower than those in control group,and the cognitive function score in observation group was higher than that in control group(P<0.01).The difference of the incidence rate of adverse reactions of anesthesia between two groups was not statistically significant(P>0.05).Conclusions:The application of low-dose ketamine combined with dexmedetomidine in patients treated with radical cervical cancer surgery can stabilize the hemodynamics,reduce serum pain mediator levels,reduce postoperative pain and fatigue,and improve immune function and cognitive function.
作者
董军久
易斌
鲁开智
DONG Jun-jiu;YI Bin;LU Kai-zhi(Department of Surgery and Anesthesia,Southwest Hospital Affiliated to Military Medical University,Chongqing 400038,China)
出处
《蚌埠医学院学报》
CAS
2022年第4期456-461,共6页
Journal of Bengbu Medical College
基金
国家自然科学基金面上项目(81670552)。
关键词
宫颈癌根治术
氯胺酮
右美托咪定
疲劳程度
疼痛介质
免疫功能
radical cervical cancer surgery
ketamine
dexmedetomidine
fatigue
pain mediator
immune function
