2025 年第 12 期 第 20 卷

右美托咪定联合七氟醚对肝癌手术患者脑氧代谢和免疫功能的影响

Effects of dexmedetomidine combined with sevoflurane on cerebral oxygen metabolism and immune function in patients undergoing liver cancer surgery

作者：王丽斯马敏吕晓敏张媛张生茂

英文作者：Wang Lisi Ma Min Lyu Xiaomin Zhang Yuan Zhang Shengmao

单位：内蒙古自治区人民医院麻醉科，呼和浩特010017

英文单位：Department of Anesthesiology Inner Mongolia People′s Hospital Hohhot 010017 China

关键词：肝癌；肝叶切除术；右美托咪定；七氟醚；苏醒质量；脑氧代谢；免疫功能

英文关键词：Livercancer;Liverlobectomy;Dexmedetomidine;Sevoflurane;Qualityofrecovery; Cerebraloxygenmetabolism;Immunefunction

• 摘要：

• 目的 探究右美托咪定联合七氟醚对原发性肝癌（PHC）行肝叶切除术患者脑氧代谢和免疫功能的影响。方法 选取2023年1月至2024年12月内蒙古自治区人民医院收治的120例PHC患者作为研究对象，采用随机数字表法分为对照组和观察组，每组60例。所有入组患者均接受肝叶切除术治疗，对照组采用七氟醚麻醉，观察组实施右美托咪定联合七氟醚麻醉。比较2组患者麻醉前（T0）、术毕即刻（T1）、术后12 h（T2）和术后24 h（T3）的心率、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、收缩压、舒张压；比较2组患者术后苏醒质量、镇静和疼痛评分、视觉模拟量表评分、出血量；比较2组患者术中及术后3 d脑氧代谢指标、术前及术后3 d免疫功能指标、不良反应发生率。结果 随时间推移，2组心率逐步降低，MAP、收缩压及舒张压先升高后降低，SpO2先降低后升高，观察组T2、T3时点SpO2较对照组更高且T1、T2、T3时点心率、MAP、收缩压、舒张压更低（均P<0.05）。观察组自主呼吸恢复时间、呼叫睁眼时间、视觉模拟量表评分、出血量均明显短于/低于/少于对照组，Ramsay镇静评分明显高于对照组，差异均有统计学意义（均P<0.05）。术后3 d，2组患者颈静脉血氧饱和度均高于术中，颈动静脉血氧含量差（AVDO2）均低于术中，且观察组颈静脉血氧饱和度、脑氧摄取率、AVDO2均低于对照组，差异均有统计学意义（均P<0.05）。术后3 d，2组患者的CD+3、CD+4、白细胞介素6、C反应蛋白均低于术前，且观察组CD+3、CD+4均高于对照组，白细胞介素6、C反应蛋白均低于对照组，差异均有统计学意义（均P<0.05）。观察组和对照组不良反应发生率比较［5.0%（3/60）比11.7%（7/60）］，差异无统计学意义（χ2=1.098，P=0.295）。结论 PHC患者行肝叶切除术治疗采用右美托咪定复合七氟醚麻醉方案可以提升苏醒质量，并能减轻对脑氧代谢的影响，提高免疫功能。

• Objective To investigate the effects of dexmedetomidine combined with sevoflurane on cerebral oxygen metabolism and immune function in patients with primary hepatocellular carcinoma (PHC) undergoing hepatectomy. Methods A total of 120 patients with PHC admitted to Inner Mongolia People′s Hospital from January 2023 to December 2024 were selected as the research objects, and they were divided into control group and observation group by random number table method, with 60 cases in each group. All patients were treated with hepatectomy. The control group was treated with sevoflurane anesthesia, and the observation group was treated with dexmedetomidine combined with sevoflurane anesthesia. Heart rate, mean arterial pressure (MAP), pulse oxygen saturation (SpO2), systolic blood pressure and diastolic blood pressure were compared between the two groups before anesthesia (T0), immediately after operation (T1), 12 h after operation (T2) and 24 h after operation (T3). The quality of recovery, sedation and pain scores, visual analogue scale scores and blood loss were compared between the two groups. The cerebral oxygen metabolism indexes during operation and 3 d after operation, immune function indexes before operation and 3 d after operation, and the incidence of adverse reactions were compared between the two groups. Results With time, heart rate gradually decreased, MAP, systolic blood pressure and diastolic blood pressure increased first and then decreased, SpO2 decreased first and then increased in the two groups. SpO2 at T2, T3 was higher and heart rate, MAP, systolic blood pressure and diastolic blood pressure at T1, T2, T3 were lower in the observation group than in the control group (all P<0.05). The recovery time of spontaneous breathing, the time of calling eyes opening, the visual analogue scale score, and the amount of bleeding in the observation group were significantly shorter/lower/less than those in the control group, and the Ramsay sedation score was significantly higher than that in the control group (all P<0.05). Three days after operation, jugular venous oxygen saturation of the two groups were higher than those during operation, and arteriovenous oxygen content difference in neck (AVDO2) was lower than that during operation, and jugular venous oxygen saturation, cerebral oxygen extraction rate and AVDO2 of the observation group were lower than those of the control group (all P<0.05). Three days after operation, the CD+3, CD+4, interleukin-6 and C-reactive protein of the two groups were lower than those before operation, and the CD+3 and CD+4 of the observation group were higher than those of the control group, and the interleukin-6 and C-reactive protein were lower than those of the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group ［5.0%(3/60) vs 11.7%(7/60)］(χ2=1.098, P=0.295). Conclusion Dexmedetomidine combined with sevoflurane anesthesia in the treatment of PHC patients undergoing hepatectomy can improve the quality of recovery, reduce the impact on cerebral oxygen metabolism, and improve immune function.