右旋美托咪啶对腹腔镜胆囊切除患者CO2气腹时血糖和IL-6的影响

目的通过观察腹腔镜胆囊切除术患者CO2气腹前静脉给予右旋美托咪啶时血糖（Glu）和IL-6的变化，探讨该药能否减轻CO2气腹的应激反应。方法将择期行腹腔镜胆囊切除术40例患者，采用随机数字表法分为对照组（C组）和右旋美托眯啶（Dex）组（D组），每组20例。D组在麻醉后手术切皮前10～15min静脉泵注Dex1．0ug／kg，其余用药两组均同。记录麻醉前30min（T1）、气腹前即刻（T2）、气腹压达12mmHg时（T3）、气腹压平衡（达12mmHg）后15min（T4）、手术结束关气腹即刻（L）的心率（HR）、平均动脉压（MAP）；并干T1、T4及T5时抽取血液标本，测定Glu和IL-6。结果C组在气腹期间HR、MAP均升高，与D组比较差异有统计学意义（P〈0．01）。D组HR、MAP在T5时较T3有显著升高（P〈O．01），但与T1相比差异无统计学意义（P〉0．05）。D组GluT5高于T1，差异有统计学意义（P〈0．05），组间比较T5低于C组，差异有统计学意义（P〈O．05）。IL-6：D组在T4、T5较T1升高，差异有统计学意义（P〈0．05）；组间比较D组T4、T5时低于对照组，差异有统计学意义（P〈0．01）。结论腹腔镜胆囊切除术患者麻醉中辅以Dex能有效减轻CO2气腹的心血管应激反应，抑制Glu和IL-6的升高，提高CO2气腹下腹腔镜手术患者围手术期的安全性。

Effect of dexmedetomidine on blood glucose and interleukin-6 levels during CO2 pneumoperitoneum in laparoscopic cholecystectomy

Objective To investigate the effect of dexmedetomidine on the stress response of CO2 pneumoperitoneum in laparoscopic cholecystectomy. Methods Forty patients aged 23- 51y, ASA Ⅰ-Ⅱ,without endocrine or cardiovascular disorders, scheduled for selective laparoscopic cholecystecomy were randomly divided into two groups： in group D dexmedetomidine （Dex） 1.0 μg/kg was given intravenously10 - 15min before operation, group C served as control. The heart rate （HR） and mean arterial pressure （MAP） were recorded at 30min before induction （T1）,immediatley before pneumoperitoneum （T2）,when the pressure of pneumoperitoneum reached 12mmHg （T3）, 15min after the pressure reached 12mmHg （T4）, immediately before shutting pneumoperitoneum of operation over （T5）. Blood glucose（Glu） and interleukin-6 （IL-6） levels were measured at T1, T4 and T5 in both groups. Results The HR and MAP during pneumoperitoneum in group C increased significantly and higher than those of group D （P〈0.01）, but showed no difference at T1（P 〉0.05）. The blood glucose levels at T5 increased significantly compared with those at T1（P〈0.05） in group D, but were lower than those in group C at T5（P〈0.05）. The IL-6 levels at T4 and T5 were higher than those at T1（P〈0.05） in group D, but were lower than those in group C at T4 and T5（P〈0.05）. Conclusion Intravenous infusion with dexmedetomidine can effectively relieve cardiovascular stress response of pneumopritoneum and inhibit the blood glucose and IL-6 in laparoscopic cholecystectomy.