诱导前应用右美托咪定对TURP术中炎症、应激反应及术后疼痛介质分泌的影响

摘要

目的:研究诱导前应用右美托咪定对经尿道前列腺切除术(T U RP)术中炎症、应激反应及术后疼痛介质分泌的影响.方法:选择2014年6月~2017年3月期间在绵阳市中心医院接受 T U RP治疗的良性前列腺增生症患者作为研究对象,随机分为接受右美托咪定联合联合椎管内麻醉的Dex组、接受椎管内麻醉的对照组.手术前及手术后1d、手术后3d时,测定两组患者血清中炎症反应指标、应激反应指标、疼痛介质的含量.结果:两组患者手术过程中血清中核因子-κB(N F-κB)、肿瘤坏死因子-α (TNF-α)、白介素(IL)-8、高迁移率族蛋白B1(HMGB1)、血管细胞黏附分子(VCAM1)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血管紧张素-Ⅱ(AT-Ⅱ)、醛固酮(ALD)、C反应蛋白(CRP)的含量均高于手术前,手术后1 d、手术后3 d时血清中降钙素基因相关肽(CGRP)、BK、SP、前列腺素E2(PGE2)的含量均高于手术前(P< 0.05),且 Dex 组患者手术过程中血清中 NF-κB、TNF-α、IL-8、HMGB1、VCAM1、Cor、ACTH、AT-II、ALD、CRP 的含量均低于对照组,手术后1 d、手术后3 d 时血清中CGRP、BK、SP、PGE2的含量均低于对照组(P<0.05).结论:诱导前应用右美托咪定对TURP术中炎症、应激反应的激活及术后疼痛介质的分泌均具有抑制作用.%Objective:To study the effect of dexmedetomidine before induction on the inflammatory and stress response in transurethral resection of prostate(TURP)and the secretion of pain mediators after it.Methods:Patients with benign pros-tatic hyperplasia who underwent TURP in Mianyang Central Hospital between June 2014 and March 2017 were selected as the research subjects and randomly divided into the Dex group who accepted dexmedetomidine combined with intraspinal anesthesia and the control group who accepted intraspinal anesthesia.The contents of inflammatory response indexes,stress response in-dexes and pain mediators in serum of the two groups were measured before surgery as well as 1 day and 3 days after surgery. Results:Serum NF-κB,TNF-α,IL-8,HMGB1,VCAM1,Cor,ACTH,AT-II,ALD and CRP levels of both groups of pa-tients during surgery were higher than those before surgery,and serum CGRP,BK,SP and PGE2 levels 1 day and 3 days after surgery were higher than those before surgery(P<0.05);serum NF-κB,TNF-α,IL-8,HMGB1,VCAM1,Cor,ACTH, AT-II,ALD and CRP levels of Dex group of patients during surgery were lower than those of control group,and serum CGRP,BK,SP and PGE2 levels 1 day and 3 days after surgery were lower than those of control group(P<0.05).Conclusion:The application of dexmedetomidine before induction has inhibitory effect on the activation of inflammatory and stress response in TURP and the secretion of pain mediators after TURP.