The Effect Of Dexmedetomidine On Inflammatory Factors In Patients With Open Hepatectomy

Objective:To investigate the effects of dexmedetomidine(DEX)intervention on early serum inflammatory factor concentration in patients undergoing open hepatectomy.Methods:Sixty patients who underwent open hepatectomy in our hospital from May 2018 to May 2019 were selected.Patients were divided into control group and dexmedetomidine group by random number table,with 30 cases in each group.In the dexmedetomidine group,DEX was injected at a loading dose of lμg/kg before induction of anesthesia,and the injection was completed in 15 minutes,followed by continuous infusion at a rate of 0.4 μg/kg/h until 30 minutes before the end of the operation.The control group was injected with the same dose of normal saline as comparison.The gender,age,weight,ASA classification,hepatic portal occlusion time,operation time,intraoperative fluid replacement,blood loss,and urine output of the two groups of patients were recorded;Mean arterial pressure(MAP)and heart rate(HR)at rest time(T0),before anesthesia induction(T1),the time of incision(T2),immediately after liver resection(T3),and at the end of surgery(T4);intraoperative circulation adverse events during the operation;4 mL of internal jugular vein blood was collected before the hepatic portal occlusion(T5),2h(T6),4h(T7),6h(T8)after the first hepatic portal opening,and the serum was centrifuged to detect the TNF-α and IL-6 concentrations Results:(1)Comparison of MAPIntra-group comparison:Compared with T0,there were no significant differences between T1 and T0(P>0.05),and the MAP of the two groups decreased at T2,T3 and T4(P<0.05)Inter-group comparison:There were no significant differences in MAP between the two groups of patients at each time point of T0-T4(P>0.05)(2)Comparison of HRIntra-group comparison:Compared with T0,there were no significant differences between T1 and T0 in the control group(P>0.05).The HR in the dexmedetomidine group decreased at T1(P<0.05).The HR of the two groups at T2,T3 and T4 were all decreased(P<0.05)Inter-group comparison:At T1,the HR of dexmedetomidine group was lower than that of the control group(P<0.05),and there were no significant differences at other time points(P>0.05)(3)Comparison of serum TNF-α and IL-6 at different time pointsIntra-group comparison:TNF-α:Compared with T5,the concentrations of TNF-α in the two groups increased at T6,T7 and T8(the control group 33.2±3.6、51.6±4.5、68.9±5.2 vs.7.1 ±0.8;the dexmedetomidine group 28.6±3.5、34.7±3.3、41.6±4.2 vs.7.5±0.6)(P<0.05).IL-6:Compared with T5,the concentrations of IL-6 in the two groups increased at T6,T7 and T8(the control group:26.1±2.0、39.2±4.2、52.0±4.3 vs.5.1±0.5;the dexmedetomidine group:18.5±1.8、25.5±3.1、32.1±3.3 vs.5.2±0.6)(P<0.05)Inter-group comparison:At T5,there were no significant differences in serum TNF-α and IL-6 between the two groups(P>0.05).At T6-T8,serum TNF-α and IL-6 concentrations in the dexmedetomidine group were significantly lower than those in the control group(TNF-α:28.6±3.5 vs 33.2±3.6、34.7±3.3 vs.51.6±4.5、41.6±4.2 vs.68.9±5.2;IL-6:18.5±1.8 vs 26.1 ±2.0、25.5±3.1 vs.39.2±4.2、32.1±3.3 vs.52.0±4.3)(P<0.05)Conclusion:DEX can reduce the early expression of serum inflammatory factors in patients undergoing open hepatectomy,and may help reduce the inflammatory response after hepatic ischemia reperfusion caused by hepatic hilar obstruction.