CAJ | 학술논문

目的：探讨右美托咪定对腹腔镜子宫全切患者循环内皮祖细胞数量的影响。方法择期行腹腔镜子宫全切术患者60例，年龄45～60岁，ASA分级Ⅰ～Ⅱ级，体重45～70 kg，采用随机数字表法，将其分为两组（n=30）：对照组（C组）和右美托咪定组（D组）。D组麻醉诱导前30 min静脉泵注负荷剂量右美托咪定1.0μg/kg，输注时间10 min，随后持续静脉泵注右美托咪定0.5μg·kg-1·h-1至术毕前30 min；C组采用同样方法静脉泵注等容量生理盐水。分别于麻醉诱导前（T0）、气腹开始时（T1）、气腹结束时（T2）和术后4 h（T3），抽取外周静脉血样2 ml，检测血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）浓度及内皮祖细胞（EPCs）数量，并记录各时间点患者平均动脉压（MAP）及心率（HR）。结果与T0时相比，C组患者T1时MAP， T1、T3时HR明显升高（P＜0.05）。与C组相比，D组患者T1时MAP及HR明显降低，T2、T3时HR明显降低（P＜0.05）；与T0时相比，两组患者T2、T3时CRP、TNF-α、IL-1β浓度均明显升高，D组患者T2、T3时外周血EPCs数量均明显增加，C组患者仅T3时EPCs数量增加（P＜0.05或0.01）。与C组比较，D组患者T2、T3时间点血清CRP、TNF-α、IL-1β浓度均明显降低，EPCs数量明显增加（P＜0.05或0.01）。结论麻醉诱导前30 min右美托咪定负荷量1.0μg/kg，术中持续静脉泵注右美托咪定0.5μg·kg-1·h-1可增加腹腔镜手术患者外周血EPCs的数量。
목적：탐토우미탁미정대복강경자궁전절환자순배내피조세포수량적영향。방법택기행복강경자궁전절술환자60례，년령45～60세，ASA분급Ⅰ～Ⅱ급，체중45～70 kg，채용수궤수자표법，장기분위량조（n=30）：대조조（C조）화우미탁미정조（D조）。D조마취유도전30 min정맥빙주부하제량우미탁미정1.0μg/kg，수주시간10 min，수후지속정맥빙주우미탁미정0.5μg·kg-1·h-1지술필전30 min；C조채용동양방법정맥빙주등용량생리염수。분별우마취유도전（T0）、기복개시시（T1）、기복결속시（T2）화술후4 h（T3），추취외주정맥혈양2 ml，검측혈청C반응단백（CRP）、종류배사인자-α（TNF-α）、백세포개소-1β（IL-1β）농도급내피조세포（EPCs）수량，병기록각시간점환자평균동맥압（MAP）급심솔（HR）。결과여T0시상비，C조환자T1시MAP， T1、T3시HR명현승고（P＜0.05）。여C조상비，D조환자T1시MAP급HR명현강저，T2、T3시HR명현강저（P＜0.05）；여T0시상비，량조환자T2、T3시CRP、TNF-α、IL-1β농도균명현승고，D조환자T2、T3시외주혈EPCs수량균명현증가，C조환자부T3시EPCs수량증가（P＜0.05혹0.01）。여C조비교，D조환자T2、T3시간점혈청CRP、TNF-α、IL-1β농도균명현강저，EPCs수량명현증가（P＜0.05혹0.01）。결론마취유도전30 min우미탁미정부하량1.0μg/kg，술중지속정맥빙주우미탁미정0.5μg·kg-1·h-1가증가복강경수술환자외주혈EPCs적수량。
ObjectiveTo investigate theeffect of dexmedetomidine on the number of endothelial progenitor cells in patients undergoing total laparoscopic hysterectomy.MethodsSixty patients of ASA gradeⅠorⅡ, aged 45-60 years, weighing 45-70 kg scheduled for laparoscopic total hysterectomy were randomly divided into 2 groups (n=30): control group (group C) and dexmedetomidine group (group D). Patients in group D were given dexmedetomidine 1.0μg/kgwithin 10 min at the time of 30 min before anesthesia induction, and then dexmedetomidine was infused at the rate of 0.5μg·kg-1·h-1during the operation until 30 min before the end of operation. Patients in group C received the same dose saline with the same way. Blood samples were collected at T0 (before anesthesia induction), T1 (at the beginning of the pneumoperitoneum), T2 (at the time of closing pneumoperitoneum) and T3 (4 h after the operation ) to determine the serum concentration of CRP, TNF-α and IL-1β. And the number of endothelial progenitor cells were calculated. MAP and HR were record at every time point.ResultsCompared with T0, MAPat T1andHR at T1, T3were significantly increased. Compared with group C, MAPat T1and HR at T1-3 ingroup D were significantly lower. Compared with T0, serum concentration of CRP, TNF-α and IL-1β were significantly increased than those at T2 and T3 in the two groups. And the number of endothelial progenitor cells were significantly increased than that at T2and T3 in group D, while the number of endothelial progenitor cells were significantly increased than that at T2 in group C (P<0.05 or 0.01). Serum concentration of CRP, TNF-α and IL-1β and the number of endothelial progenitor cells in group D were significantly increased than those in group C at T2 and T3 (P<0.05 or 0.01) when compared with group C.Conclusion Loading of dexmedetomidine 1.0μg/kg 30 min before anesthesia induction and then infusing dexmedetomidine at the rate of 0.5 μg·kg-1·h-1 during the operation can increase the number of endothelial progenitor cells in patients undergoing total laparoscopic hysterectomy.