Effects Of Dexmedetomidine On Stress Response And Cellular Immune In Patients With Gynecologic Malignancies Undergoing Laparoscopic Surgery

Objective:To explore the effect of dexmedetomidine on stress response and cellular immune in patients with gynecologic malignancies undergoing laparoscopic surgery.Methods:Sixty patients with gynecological malignancies who scheduled to undergo laparoscopic surgery under general anesthesia in the Second Hospital of Shanxi Medical University from March 2021 to March 2022 were selected.The patients were divided into two groups according to the random number table method,with 30 cases in each group.The DEX group included 12 cases of cervical cancer,10 cases of endometrial cancer,and 8 cases of ovarian cancer;the control group included 14 cases of cervical cancer,9 cases of endometrial cancer,and 7 cases of ovarian cancer.DEX group:intravenous anesthesia was induced with a dose of DEX 0.5μg·kg^-1（infusion was completed within 10 min）,general anesthesia was maintained with DEX 0.2μg·kg^-1·h^-1 pumped intravenously,and the drug was stopped 30minutes before the end of the surgery.Control group:equal amount of 0.9%sodium chloride solution pumped intravenously.The venous blood was drawn at the time points of 10 min（T₀）before general anesthesia,at the end of operation（T₁）and 1 day after operation（T₂）to detect the changes of stress response indicators such as cortisol（COR）,epinephrine（E）,norepinephrine（NE）,and immune indicators such as CD4⁺,CD8⁺,and CD4⁺/CD8⁺at T₀,T₁,and T₂.In addition,the pneumoperitoneum time,general anesthesia time,operation time and the first postoperative exhaust time were recorded.Results:At T₀,there were no statistically significant differences in the levels of COR,E and NE between the DEX group and the control group（all P>0.05）.At T₁,the levels of COR,E and NE in the DEX group were lower than those in the control group（t values were-2.51,-2.37,-2.08,all P<0.05）.At T₂,the levels of COR,E and NE in the DEX group were also lower than those in the control group（t values were-2.35,-2.23,-2.17,all P<0.05）.At T₀,there were no statistically significant differences in the number of CD4⁺,CD8⁺T cells,and the ratio of CD4⁺/CD8⁺between the DEX group and the control group（all P>0.05）.At T₁,the number of CD4⁺,CD8⁺T cells,and the ratio of CD4⁺/CD8⁺in the DEX group were higher than those in the control group（t values were-3.43,-2.29,2.13,all P<0.05）.At T₂,the number of CD4⁺,CD8⁺T cells,and the ratio of CD4⁺/CD8⁺in the DEX group were higher than those in the control group（t values were-4.32,-2.02,2.02,all P<0.05）.In addition,the time of first exhaust in the DEX group was shorter than that in the control group（P<0.05）.Conclusion:DEX can effectively alleviate the stress response and improve the immunosuppressive of laparoscopic surgery in gynecological malignancy patients,thereby protecting the immune function.At the same time,it is also of great significance for restoring intestinal function and helping to accelerate patient recovery.