Application Of Ibuprofen Combined With Dexmedetomidine In Laparoscopic Cholecystectomy

Objective:The purpose is to study the effect of ibuprofen pre-administration combined with dexmedetomidine in laparoscopic cholecystectomy,to compare the stress response and cellular immune function of patients by observing the hemodynamic changes of patients during perioperative period and measuring the changes of serum cortisol,pro-inflammatory cytokines and T lymphocyte subsets,in order to explore their internal relationship and mechanism,and to provide a theoretical basis for clinical optimization of anesthesia,pain management and prognosis during perioperative period of laparoscopic cholecystectomy.Then it can be better used in clinic and helping patients recover quickly after surgery.Methods:120 patients with laparoscopic cholecystectomy in our hospital were randomly divided into group A:control group（n=40）,group B:dexmedetomidine group（n=40）,and group C:ibuprofen+dexmedetomidine group（n=40）.In group A,20 ml of normal saline（NS）was administered orally 4 to 6 hours before the operation,and the saline was continuously pumped for 10 min before induction of anesthesia.In group B,20 ml of normal saline was continuously injected orally 4 to 6 hours before the operation,and dexmedetomidine（DEX,4μg/ml,0.5μg/kg）was continuously injected into the veins before anesthesia induction for 10 minutes.In group C,20 ml of ibuprofen was continuously injected orally 4 to 6 hours before the operation,and dexmedetomidine（4μg/ml,0.5μg/kg）was continuously pumped intravenously before anesthesia induction for 10 minutes.Observing and recording the hemodynamic changes at each time point of T1（6 hours before anesthesia）,T2（immediately after intubation）,T3（pneumoperitoneum establishment 5 minutes）,T4（pneumoperitoneum establishment 10 minutes）,T5（immediate extubation）,T6（30minutes after extubation）.Observing and recording the extubation time,the situation of sedation or restlessness and VAS pain score of patients 5 minutes after extubation,the adverse reactions of patients 24 hours after surgery,and the volume of use of opioids perioperative stage.The protein content of Cor and proinflammatory cytokines such as CRP,IL-6 and TNF-αwere measured in serum at different time points from T1 to T6.Measuring the content of T lymphocyte subsets such as CD3⁺,CD4⁺,and CD8⁺of body at T1 before operation and 24 hours after operation,and calculating the ratio of CD4⁺/CD8⁺.Result:1.Hemodynamic changes in each groupAt time T1,there was no significant difference in SBP,DBP,and HR between the three groups（P>0.05）;at time T6,there was no significant difference in SBP,DBP between the three groups（P>0.05）,but compared with group A,the HR of group B and C was significantly reduced（P<0.05）;at time T2-T5,the changes of SBP,DBP and HR in group B and C were stable,and there was no significant difference between groups（P>0.05）;Compared with group A,the blood pressure and heart rate were also reduced significantly（P<0.05）.At last,there was no significant difference in the comparison of perioperative SpO₂ between the three groups（P>0.05）.2.Comparison of plasma Cor,CRP,IL-6 and TNF-αconcentrations in each groupAt time T1,there was no significant difference about the protein levels of Cor,CRP,IL-6 and TNF-αin serum between the three groups（P>0.05）.Compared with group A,the protein levels of Cor,CRP,IL-6 and TNF-αin serum at time T2-T6 in group B and C were significantly reduced（P<0.05）;the protein level of IL-6 in serum at time T2-T6 in group C was lower than group B Significantly（P<0.05）.3.Comparison of immune function levels in each groupAt time T1,there was no significant difference in CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺between the three groups（P>0.05）.The content of CD3⁺,CD4⁺,CD8⁺,and CD4⁺/CD8⁺in the three groups 24 hours after operation were significantly lower than those at time T1（P<0.05）.However,the content of CD3⁺,CD4⁺,CD8⁺,and CD4⁺/CD8⁺in group B and C were significantly higher than those in group A 24 hours after operation（P<0.05）.4.Comparison of extubation time,and sedation-restlessness or pain scores after extubationor,and how much of opioid use perioperative period,and adverse reactions of postoperative in each groupThere was no significant difference in extubation time between the three groups（P>0.05）.The sedation-restlessness score and pain score after extubation in groups B and C were significantly lower than those in group A（P<0.05）.During the perioperative period,the content of use of opioids in group B and C was significantly reduced（P<0.05）,compared with group A.The incidence of postoperative nausea and vomiting in group B and C was significantly lower than that in group A（P<0.05）.Conclusion:Pre-administration of ibuprofen combined with dexmedetomidine can effectively inhibit the stress response,reduce cellular immunosuppression,maintain hemodyna-mic stability of patients undergoing laparoscopic cholecystectomy,besides,it can also reduce postoperative sedation-restlessness score,pain score,adverse reactions and the volume of use of opioid drugs during the perioperative period.Therefore,this technical method can be used for clinical research and promotion furtherly.