目的 探討右美托咪定對婦科腹腔鏡手術患者圍術期炎癥因子及應激反應的影響。方法 選擇180例婦科腹腔鏡手術患者，隨機分為兩組，每組90例。對照組患者靜脈輸注0.5 μg/kg舒芬太尼、1.8 mg/kg丙泊酚、0.6 mg/kg羅庫溴銨進行麻醉誘導，術中吸入七氟醚行麻醉維持，并間斷靜脈推注順苯磺阿曲庫銨維持肌松。觀察組麻醉誘導前靜脈泵注0.5 μg/kg右美托咪定負荷劑量，之后以0.5 μg/（kg·h）輸注至術畢前10 min，其余麻醉方法與對照組相同。觀察麻醉誘導前10 min（T₀）、氣管插管后即刻（T₁）、建立氣腹時（T₂）、氣腹建立30 min后（T₃）、手術結束時（T₄）5個時間點的血流動動力學變化情況，使用酶聯(lián)免疫吸附法檢測炎癥指標，以及血管緊張素Ⅱ、皮質醇及醛固酮等應激反應指標。結果 與T₀時間點比較，觀察組T₁～T₃ 心率（HR）均明顯下降（P<0.05），對照組T₁～T₃ HR均明顯上升（P<0.05），對照組發(fā)生心動過速1例，觀察組未發(fā)生；與T₀時間點比較，觀察組T₁～T₄有創(chuàng)平均動脈壓（MAP）未發(fā)生明顯變化，對照組T₁～T₄ MAP明顯上升，組間比較差異明顯（P<0.05）；與T₀時間點比較，兩組的IL-6、IL-10及TFN-α均明顯上升，而對照組上升程度明顯高于觀察組（P<0.05）；與T₀時間點比較，兩組的血管緊張素Ⅱ、皮質醇及醛固酮均明顯上升，且對照組上升程度明顯高于觀察組（P<0.05）。結論 麻醉誘導前靜脈泵注0.5 μg/kg右美托咪定負荷劑量，之后以0.5 μg/（kg·h）輸注至術畢前10 min，可以維持婦科腹腔鏡手術圍術期的血流動力學穩(wěn)定，抑制圍術期炎癥反應及應激反應。

Objective To investigate the influence of dexmedetomidine on perioperative period inflammatory factor and stress reaction in patients with gynecological laparoscopic operation. Methods Totally 180 cases of gynecologic laparoscopic surgery were randomly divided into two groups, 90 cases in each group. The patients in control group were iv given 0.5 g/kg and 1.8 mg/kg propofol, sufentanil 0.6 mg/kg rocuronium anesthesia. With inhalation of sevoflurane to maintain anesthesia, and intermittent iv injection of Cisatracurium Besylate for Injection to maintain muscle relaxation. The patients in observation group were given 0.5 ìg/kg dexmedetomidine before anesthesia induction, and 0.5 μg/(kg·h) infusion to 10 min before the end of surgery, the others anesthesia were same with the control group. Observation The blood flow dynamics were observed at five time points such as 10 min before anesthesia (T₀), after tracheal intubation immediately (T₁), establishment of pneumoperitoneum (T₂), after pneumoperitoneum established 30 min (T₃), and at the end of surgery (T₄). Using enzyme-linked immunosorbent assay, the inflammatory markers, as well as angiotensin Ⅱ, cortisol, aldosterone, and other stress response indicators were detected. Results The HR of observation group at T₁ to T₃ was lower than that at T₀ (P<0.05), while the HR of the control group was obviously higher (P<0.05). The tachycardia of the control group was 1 case, the observed had none, without significant difference. Compared with T₀, the MAP of the observation group at T₁ to T₄ had no significant difference, while that of the control group was obvious higher, with significant difference (P<0.05). Compared with before anesthesia induction for 10 min, the IL-6, IL-10, and TFN-α of two groups were obviously higher (P<0.05), while the rising degree of the control group were higher than the observation group (P<0.05). Compared with before anesthesia induction for 10 min, the angiotensin Ⅱ, cortisol, and aldosterone of two groups were obviously higher (P<0.05), the rising degree of the control group were higher than the observation group (P<0.05). Conclusion Before anesthesia induction given 0.5 ìg/kg dexmedetomidine, and 0.5 ìg/(kg·h) infusion to 10 min before the end of surgery, which could maintain the gynecologic laparoscopic surgery perioperative hemodynamic stability and control the perioperative inflammatory response and stress response.