关键词: 胆囊切除术, 腹腔镜, 右美托咪啶, 血流动力学

Abstract: Objective To investigate the effects of dexmedetomidine before induction of general anesthesia on intraoperative hemodynamics, postoperative analgesia, inflammatory factors and glycocalyx in patients undergoing laparoscopic cholecystectomy. 
Methods A total of 200 patients with cholecystolithiasis complicated with acute cholecystitis undergoing laparoscopic cholecystectomy under general anesthesia in our hospital were randomly divided into an observation group (n=100) and a control group (n=100). In the control group, 10 mL of 0.9% sodium chloride solution was injected intravenously before induction of general anesthesia, while dexmedetomidine (0.8 μg/kg) was injected in the observation group. The hemodynamics, duration of operation, duration of anesthesia, time to extubation, duration of minimum alveolar concentration equal to 1, degree of postoperative pain, incidence of adverse effects, leukocyte values, interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin and glycocalyx injury markers (syndecan-1, heparan sulfate, hyaluronic acid) were observed in the two groups. 
Results This study showed that there was no difference between the two groups in terms of general characteristics such as duration of operation, duration of anesthesia, and time to extubation.However, the observation group was able to maintain intraoperative hemodynamic parameters better (P＜0.05), and the visual analogue scale (VAS) scores of the observation group were significantly lower than those of the control group at 3 h, 6 h, 9 h, and 12 h postoperatively; the difference of interaction between groups, time points and time points between groups were statistically significant (P＜0.05). Although the postoperative leukocyte values were comparable, the postoperative levels of inflammatory factors and glycocalyx injury markers were different between the two groups. The levels of IL-1, IL-6, IL-8, TNF-α, CRP, procalcitonin, and glycocalyx injury markers in the observation group were significantly lower than those in the control group (P＜0.05). In addition, the incidence of postoperative adverse reactions in the observation group was significantly lower than that in the control group (P＜0.05). 
Conclusion In patients undergoing laparoscopic cholecystectomy for cholecystolithiasis with acute cholecystitis, the administration of dexmedetomidine before induction of general anesthesia can better maintain intraoperative hemodynamic parameters, effectively improve postoperative pain, and reduce the occurrence of postoperative inflammation and adverse reactions. In addition, it can inhibit the shedding of vascular endothelial glycocalyx and improve the immune function of the body, and thus promote the recovery of patients after surgery.

Key words: cholecystectomy, laparoscopic, dexmedetomidine, hemodynamics