张努 徐连生

[摘要] 目的 探討右美托咪定联合利多卡因对腹腔镜全子宫切除术患者氧化应激和炎性反应的影响。 方法 选取2014年9月～2017年10月宜宾市第一人民医院妇科全麻行腹腔镜全子宫切除术患者120例为研究对象，根据随机数字表法将其分为A、B、C组和对照组，各30例。A组予以右美托咪定联合利多卡因静脉泵注，B组予以右美托咪定静脉泵注，C组予以利多卡因静脉泵注，对照组予以生理盐水静脉泵注。于给药前（T1）、手术结束时（T2）、术后2 h（T3）和术后24 h （T4）对氧化应激指标[过氧化氢（H2O2）、丙二醛（MDA）、总抗氧化态（TAS）]及炎性因子[白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]进行监测。比较四组术后不良反应发生率。 结果 在T2、T3、T4时，血清H2O2、MDA水平A组B组>C组>对照组，组间比较差异有差异统计学意义（P < 0.05）；血清IL-6、TNF-α水平A组

[关键词] 右美托咪定；利多卡因；腹腔镜全子宫切除术；氧化应激；炎性反应

[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2018）04（a）-0095-05

[Abstract] Objective To expiore the effects of Dexmedetomidine combined with Lidocaine on oxidative stress and inflammatory response in patients with laparoscopic total hysterectomy. Methods One hundred and twenty patients with laparoscopic total hysterectomy in gynaecology of the First People′s Hospital of Yibin from September 2014 to October 2017 were selected as the subjects. According to the random digital table method，120 patients were divided into group A， B， C and control group， 30 cases in each group. Group A was treated with dexmedetomidin combined with Lidocaine by intravenous pump. Group B was treated with Dexmedetomidine by intravenous pump. Group C was treated with Lidocaine by intravenous pump. The control group treated with normal saline by intravenous pump. The inflammatory factors （IL-6， TNF-α） and oxidative stress indexes （H2O2， MDA and TAS） were monitored before administration （T1）， at the end of operation （T2）， 2 h after operation （T3） and 24 h after operation （T4）. The incidence of postoperative adverse reactions was compared between the four groups. Results At T2， T3 and T4， levels of serum H2O2 and MDA， group A < group B< group C< control group， the difference between groups was statistically significant （P < 0.05）. Levels of serum IL-6， TNF-α in group A < group B< group C< control group， and the TAS leves， group A> group B> group C> control group， the difference between groups was statistically significant （P < 0.05）. The incidence of nausea and vomiting in group A was lower than that in group B and control group， the difference was statistically significant （P < 0.05）. The incidence of somnolence and bradycardia in group A and B was higher than that in group C and control group， the difference was statistically significant （P < 0.05）. Conclusion Dexmedetomidine combined with Lidocaine can alleviate the oxidative stress response and inflammatory response in patients with laparoscopic total hysterectomy. However， the incidence of somnolence and bradycardia increased after operation.

[Key words] Dexmedetomidine； Lidocaine； Laparoscopic hysterectomy； Oxidative stress； Inflammatory response

大子宫肌瘤或多发性子宫肌瘤所致大子宫是妇科常见疾病，目前临床上主要采用腹腔镜全子宫切除术治疗，而手术及麻醉均会导致机体氧化应激水平和炎性反应改变[1-2]。不同麻醉药对患者氧化应激水平及炎性反应产生不同的影响。研究报道，对行腹腔镜全子宫切除术患者予以右美托咪定或利多卡因辅助麻醉均可抑制手术刺激、创伤及内毒素诱导的氧化应激和炎性反应[3-5]。国内关于右美托咪定联合利多卡因辅助麻醉对行腹腔镜全子宫切除术患者的氧化应激及炎性反应的影响报道较少。……