右美托咪定作为辅助药物在接受腹腔镜胆囊切除术患者中的应用效果：一项随机前瞻性临床试验。

Outcomes of dexmedetomidine as adjuvant drug in patients undergoing videolaparoscopic cholecystectomy: A randomized and prospective clinical trial.

机构信息

Department of Anesthesiology, Gaffreé e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.

Department of Anesthesiology, University Hospital of Juiz de Fora Federal University, Juiz de Fora, Brazil.

出版信息

Int J Immunopathol Pharmacol. 2023 Jan-Dec;37:3946320231196977. doi: 10.1177/03946320231196977.

DOI:10.1177/03946320231196977

PMID:37604516

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10467245/

Abstract

OBJECTIVE

The repercussions of ischemia-reperfusion and inflammatory response to surgical injury may compromise the return of physiologic processes in video-laparoscopic surgeries. Dexmedetomidine, as an adjuvant drug in general anesthesia, alters the neuroinflammatory reaction, provides better clinical outcomes in the perioperative period, and may reduce the excessive use of chronic medication in patients with a history of addiction. This study evaluated the immunomodulatory potential of dexmedetomidine on perioperative organ function in video-laparoscopic cholecystectomy patients.

METHODS

There were two groups: Sevoflurane and Dexmedetomidine A (26 patients) vs. Sevoflurane and Saline 0.9% B (26 patients). Three blood samples were collected three times: 1) before surgery, 2) 4-6h after surgery, and 3) 24h postoperatively. Inflammatory and endocrine mediators were protocolized for analysis. Finally, hemodynamic outcomes, quality upon awakening, pain, postoperative nausea and vomiting, and opioid use were compared between groups.

RESULTS

We have demonstrated a reduction of Interleukin 6 six hours after surgery in group A: 34.10 (IQR 13.88-56.15) vs. 65.79 (IQR 23.13-104.97; = 0.0425) in group B. Systolic blood pressure, diastolic blood pressure, and mean arterial pressure was attenuated in group A in their measurement intervals ( < 0.0001). There was a lower incidence of pain and opioid consumption in the first postoperative hour favoring this group ( < 0.0001). We noticed better quality upon awakening after the intervention when comparing the values of peripheral oxygen saturation and respiratory rate.

CONCLUSIONS

Dexmedetomidine provided anti-inflammatory benefits and contributed to postoperative analgesia without the depressive side effects on the respiratory and cardiovascular systems commonly observed with opioids.

TRIAL REGISTRATION

Immunomodulatory Effect of Dexmedetomidine as an Adjuvant Drug in Laparoscopic Cholecystectomies, NCT05489900, Registered 5 August 2022-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05489900?term=NCT05489900&draw=2&rank=1.

摘要

目的

缺血再灌注和手术损伤引起的炎症反应可能会影响视频腹腔镜手术中生理过程的恢复。右美托咪定作为全身麻醉的辅助药物，可改变神经炎症反应，在围手术期提供更好的临床结果，并可能减少有滥用药物史患者对慢性药物的过度使用。本研究评估了右美托咪定对视频腹腔镜胆囊切除术患者围手术期器官功能的免疫调节作用。

方法

有两组：七氟醚和右美托咪定 A 组（26 例）与七氟醚和生理盐水 0.9% B 组（26 例）。采集三组血样：1）手术前，2）手术后 4-6 小时，3）手术后 24 小时。方案规定分析炎症和内分泌介质。最后，比较两组之间的血流动力学结果、苏醒质量、疼痛、术后恶心呕吐和阿片类药物使用情况。

结果

我们发现 A 组术后 6 小时白细胞介素 6 减少：34.10（IQR 13.88-56.15）vs. 65.79（IQR 23.13-104.97；=0.0425）B 组。A 组在测量间隔内收缩压、舒张压和平均动脉压均减弱（<0.0001）。在术后第一小时疼痛和阿片类药物的使用发生率较低，有利于该组（<0.0001）。我们注意到干预后外周血氧饱和度和呼吸频率的苏醒质量更好。