| Research BackgroundCervical carcinoma and endometrial carcinoma are two common gynecologic malignancies.Among them,cervical cancer is the most common gynecological malignant tumor,with a high incidence between 50 and 55 years old.In recent years,the incidence of cervical cancer has gradually increased.In China,there are about140,000 new cases of cervical cancer and about 37,000 deaths every year,and the age of onset is getting younger and younger.The etiology of cervical cancer is clear.Surgical treatment is generally adopted in the early stage.The advantage of surgical treatment is that young patients can retain ovarian and vaginal functions.Endometrial carcinoma is one of the three major malignant tumors of the female genital tract.The incidence rate has been on the rise in recent years.Surgery is the main method for early-stage patients.Long ago,cervical cancer and endometrial cancer were alloperated by traditional laparotomy,with big trauma,much bleeding,and slow postoperative recovery.The development of science and technology promotes the progress of clinical diagnosis and treatment.In this environment,laparoscopy is developed and applied.Doctors are constantly seeking to achieve better therapeutic effects with less trauma.Laparoscopic surgery has developed rapidly in the treatment of gynecologic malignant tumors.The advantages of laparoscopic surgery are related to the shorter hospital stay and earlier recovery of normal activities and work.Avoiding laparotomy can reduce the incidence of cicatricial hernia.By reducing surgical trauma,the incidence of postoperative adhesion can be reduced.Laparoscopic surgery has shown revolutionary advances in the past few decades.This is due to its advantages over laparotomy,such as better puncture,less postoperative pain,faster recovery,shorter hospital stay,and lower overall care costs.For these reasons,laparoscopy has become the first choice for various diseases.Compared with open surgery,laparoscopic surgery improves the short-term and long-term quality of life of patients and is the best method for early treatment of cervical cancer.However,laparoscopic surgery requires carbon dioxide(CO2)pneumoperitoneum to provide a good operating environment and a special body position with low head and high feet,which causes the patient’s heart and lungs to be squeezed,sustained hypoxia and low perfusion.Combined with anesthesia and stimulation of surgery,the lung function of patients is damaged,so the perioperative protection of patients’ lungs during laparoscopic surgery is of great significance.Dexmedetomidine is a new type of highly selective α 2 adrenergic receptor agonist,which has strong sedative,analgesic,sympathetic nerve inhibitory and other effects,and has the advantages of no respiratory inhibition and easy awakening.Dexmedetomidine can assist anesthesia.Studies have shown that the perioperative use of dexmedetomidine can reduce the use of opioid drugs.Other studies haveconfirmed that dexmedetomidine can reduce lung tissue damage and the incidence of postoperative complications by inhibiting inflammatory reaction in thoracic surgery.However,the protective effect of dexmedetomidine injection in gynecological laparoscopic surgery has not been determined,so this study intends to explore the protective effect of dexmedetomidine injection on the lung function of patients undergoing a laparoscopic extensive hysterectomy and pelvic lymph node dissection for gynecological malignant tumors caused by cervical cancer and endometrial cancer.PurposeTo study the protective effect of dexmedetomidine on the lung of gynecologic malignant tumor patients for laparoscopic surgery.MethodWith the approval of the Ethics Committee of the Second Affiliated Hospital of Zhengzhou University,100 patients,aged 36-69 years,weighing 49-72 kg and ASA grade I-II,who underwent elective laparoscopic extensive hysterectomy and pelvic lymphadenectomy for cervical cancer and endometrial cancer in our hospital from May 2018 to December 2018 were selected as the study subjects.The 100 patients included were randomly divided into 2 groups,the dexmedetomidine group(group D)and the control group(group C),50 cases in each group.After conventional rapid anesthesia induction,tracheal intubation was performed under the aid of visual laryngoscope,bilateral lung ventilation was satisfactory,and static inhalation combined anesthesia was used during the operation.In group D,the patients were given dexmedetomidine 1.0 ug/kg intravenously before induction of anesthesia for 10 minutes,and dexmedetomidine 0.5 ug/(kg h)was continuously pumped during the operation until 30 minutes before the end of the operation;In group C,the patients were given 0.9% sodium chloride(NaCl)injection of the same amount.The systolicblood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded before anesthesia induction(T0),5 min after intubation(T1),30 min after pneumoperitoneum(T2),60 min after pneumoperitoneum(T3),15 min after pneumoperitoneum closure(T4),5 min after extubation(T5)and 24 hours after operation(T6)in the two groups respectively.Peak airway pressure(Ppk)and dynamic lung compliance(Cdyn)were recorded at T1-T4 time points,and arterial blood gas analysis was performed to calculate the oxygenation index(OI).Venous blood of the upper extremity was extracted at T0,T2,T3,T4,and T6,respectively,to detect the serum concentrations of tumor necrosis factor(TNF-α)and interleukin-6(IL-6).Results1.There were no statistically significant differences between the two groups in age,weight,time of surgery,time of pneumoperitoneum,the time between extubation and the end of surgery,and the proportion of cervical cancer and endometrial cancer(P>0.05).2.There were no significant differences in systolic blood pressure,diastolic blood pressure and heart rate between the two groups at T0 time point(P>0.05).The systolic blood pressure of patients in group D was lower than that in group C at T1 and T5,the difference was statistically significant(P< 0.05).The diastolic blood pressure in group D was lower than that in group C at time points T1 and T5,the difference was statistically significant(P < 0.05).The heart rate of patients in group D was lower than that in group C at time points T1,T4,and T5,and the difference was statistically significant(P<0.05).3.Compared with T0 time point,the serum TNF-α and IL-6 concentrations of the two groups of patients at T2,T3,T4,and T6 time points were all increased,with statistically significant differences(P<0.05).There were no significant differences in serum TNF-α and IL-6 concentrations between the two groups at T0(P > 0.05).In group D,TNF-α and IL-6 were lower than those in group C at T2,T3,T4,and T6 time points,the differences were statistically significant(P<0.05).4.Compared with T1,Ppk in T2,T3 and T4 time points of the two groups of patients increased,with statistically significant differences(P<0.05).Cdyn and OI in the two groups were lower than those in T1 at T2,T3,and T4 time points,and the differences were statistically significant(P<0.05).There were no significant differences in Ppk,Cdyn,OI between the two groups(P>0.05).The Ppk of patients in group D was lower than that in group C at T2,T3 and T4 time points,the difference was statistically significant(P<0.05),while the Cdyn and OI of patients in group D were higher than that in group C at T2,T3 and T4 time points,the differences were statistically significant(P<0.05).ConclusionIn the treatment of cervical cancer and endometrial cancer with laparoscopic surgery,dexmedetomidine can play a protective role in the lung by inhibiting pulmonary inflammatory response,improving pulmonary compliance and oxygenation index of patients. |
