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Effects of dexmedetomidine on perioperative stress response inflammation and immune function in patients with different degrees of liver cirrhosis

机译：右美托咪定对不同程度肝硬化患者围手术期应激反应炎症和免疫功能的影响

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Effects of dexmedetomidine (DEX) on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis were investigated. A total of 94 patients with liver cirrhosis who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from December 2016 to November 2017 were included, and randomly divided into control and observation group (n=47). Patients in control group were given remifentanil for anesthesia, while patients in observation group were treated with remifentanil and for DEX anesthesia. Venous blood was collected immediately before induction of anesthesia (T1), 10 min (T2) after the beginning of surgery, immediately after surgery (T3) and 2 h after surgery (T4). Hemodynamic parameters, stress response factors, adverse reactions and levels of inflammatory cytokines and T lymphocyte subsets were compared between the two groups. The mean arterial pressure in both groups was lower at T2-T4 than that at T1 (p<0.05), and mean arterial pressure was lower in observation group than in control group (p<0.05). Visual analogue pain score (VAS) of observation group was significantly lower than that of control group at 6, 12 and 24 h after operation (p<0.05). There was no significant difference between the two groups in incidence of nausea, vomiting, hypoxemia and delayed awakening (p>0.05). Incidence of postoperative agitation in observation group was significantly lower than that in control group (p<0.05). The levels of CD3+, CD4+, and CD4+/CD8+ in both groups were significantly lower at T2-T4 than those at T1 (p<0.05). Levels of IL-10 and TNF-α in both groups were significantly higher at T2-T4 than those at T1, but levels of IL-2 and TNF-α were significantly lower in observation group than in control group (p<0.05). In conclusion, the use of DEX for anesthesia in patients with liver cirrhosis can improve hemodynamic stability, reduce stress response and reduce inflammation level without affecting immune function, which has important clinical significance.
机译：研究了右美托咪定（DEX）对不同程度肝硬化患者围手术期应激反应，炎症和免疫功能的影响。纳入2016年12月至2017年11月在山东中医药大学附属医院收治的94例肝硬化患者，随机分为对照组和观察组（n = 47）。对照组给予瑞芬太尼麻醉，观察组给予瑞芬太尼和DEX麻醉。麻醉诱导前（T1），手术开始后10分钟（T2），手术后立即（T3）和手术后2小时（T4）收集静脉血。比较两组的血流动力学参数，应激反应因子，不良反应以及炎性细胞因子和T淋巴细胞亚群的水平。两组的平均动脉压在T2-T4均低于T1（p <0.05），观察组的平均动脉压低于对照组（p <0.05）。观察组术后6、12、24 h的视觉模拟疼痛评分（VAS）明显低于对照组（p <0.05）。两组的恶心，呕吐，低氧血症和延迟醒的发生率无显着差异（p> 0.05）。观察组术后躁动发生率明显低于对照组（p <0.05）。两组的CD3 + ，CD4 + 和CD4 + / CD8 + 的水平均明显低于T2-T4高于T1（p <0.05）。两组在T2-T4时IL-10和TNF-α的水平均显着高于T1，但观察组的IL-2和TNF-α的水平显着低于对照组（p <0.05）。总之，在肝硬化患者中使用DEX麻醉可改善血液动力学稳定性，降低应激反应和降低炎症水平而不影响免疫功能，这具有重要的临床意义。

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