右美托咪定对妇科腔镜手术CO2气腹肠损伤的影响

目的:探讨右美托咪定（DEX）对妇科腹腔镜手术CO2气腹过程中肠损伤的影响。方法:选取拟在全麻下行腹腔镜下子宫肌瘤剔除术的多发子宫肌瘤患者40例，按随机数字表法分为实验组和对照组，每组各20例，对照组常规行静脉麻醉诱导和维持；实验组常规麻醉诱导前给予DEX负荷剂量0.5 μg/kg（10 min内输注完毕），常规行静脉麻醉诱导，DEX改为维持剂量0.2 μg/(kg·h)直至手术结束，在麻醉诱导前10 min（T1），气腹解除后1 h（T2），气腹解除后24 h（T3）分别取两组患者的静脉血，测定血清中紧密连接蛋白claudin-1和二胺氧化酶（DAO）含量，观察比较两组患者claudin-1和DAO的变化规律以及使用DEX预处理后对claudin-1和DAO表达的影响。结果:对照组患者血清claudin-1含量T2、T3时刻低于T1时刻，差异具有统计学意义（P＜0.001），DAO含量T2、T3时刻均大于T1时刻，差异具有统计学意义（P＜0.001）；实验组患者claudin-1和DAO含量在不同时间点比较差异无统计学意义，实验组患者claudin-1蛋白含量在T2、T3时刻均高于对照组患者T2、T3时刻蛋白含量（P＜0.05,P＜0.01），实验组患者DAO含量在T2、T3时刻均低于对照组患者T2、T3时刻DAO含量（P＜0.001，P＜0.05）。结论:妇科腔镜手术CO2气腹会造成一定的肠损伤；DEX预处理后，通过上调肠上皮细胞claudin-1蛋白表达，增强肠上皮细胞屏障功能，使释放入血的DAO含量减少，说明DEX干预对CO2气腹造成的肠损伤具有一定的防治作用。

Effect of dexmedetomidine on CO2 pneumoperitoneum injury in gynecological laparoscopic surgery

Objective:To investigate the effect of dexmedetomidine (DEX) on intestinal injury during CO2 pneumoperitoneum in gynecological laparoscopic surgery.Methods:40 patients with multiple myoma of uterus undergoing laparoscopic myomectomy under general anesthesia were randomly divided into two groups,including experimental group (n=20) and control group (n=20).The control group received intravenous anesthesia induction and maintenance.In the experimental group,DEX was given a loading dose of 0.5 μg/kg before induction of general anesthesia (10 min after infusion),and intravenous anesthesia was given routinely.DEX was maintained at 0.2 μg/(kg·h) until the end of operation.DEX was given 10 min before induction of general anesthesia (T1) and one hour after ventilation (T2),the levels of tight junction protein claudin-1 and diamine oxidase (DAO) in serum were measured at 24 h (T3) after ventilation,the changes of claudin-1 and DAO were observed and compared between the two groups,and the effects of pretreatment with DEX on the expression of claudin-1 and DAO.Results:The serum claudin-1 levels in the control group were significantly lower at T2 and T3 than at T1(P＜0.001),and the levels of DAO were significantly higher at T2 and T3 than at T1(P＜0.001).The content of claudin-1 and DAO in the experimental group had no significant difference at different time points.The content of claudin-1 protein in the experimental group was higher than that in the control group at T2 and T3(P＜0.05,P＜0.01),the content of DAO in experimental group was lower than that in control group at T2 and T3(P＜0.001,P＜0.05).Conclusion:CO2 pneumoperitoneum can cause intestinal injury in gynecologic laparoscopic surgery,and after DEX pretreatment,the intestinal epithelial cell barrier function was enhanced by up-regulating claudin-1 protein expression,and the content of DAO released into the blood was decreased,the results showed that DEX intervention could prevent and cure intestinal injury caused by CO2 pneumoperitoneum.