肺癌患者术后在ICU应用右美托咪定对免疫功能的影响  

Effects of Dexmedetomidine on Postoperative Immune Function of Lung Cancer Patients in ICU

作　　者：周明明[1] 袁建国[1] 周艳红[1] 张宁[1] 

机构地区：[1]重庆市肿瘤研究所ICU,重庆400030

出　　处：《中国药房》2014年第18期1685-1687,共3页China Pharmacy

摘　　要：目的：观察肺癌患者术后在iCU应用右美托咪定后免疫功能的变化，初探其可能机制。方法：肺癌全麻术后带气管插管导管入重症监护室（ICU）患者48例，随机分为D组与M组。其中M组患者入科后即予右美托咪定0．2～0．7μg／（kg·h）持续泵入镇静镇痛，维持Ramsay镇静评分在3分左右，直至术后第1天早晨停用。D组予同等量生理盐水泵入，给药时间同M组。两组分别于手术前l天（T0）、拔管即刻（T1）、术后1天（T2）和术后2天（T3）晨抽取外周静脉血，测定免疫功能总T淋巴细胞（CD3＋）、Th细胞（cD3＋CD4＋）、Ts细胞（CD3＋CD8＋）、NK细胞（CDl6＋56）的绝对数，采用酶联免疫吸附法（ELISA）测定血清肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）水平。结果：两组患者术后CD3＋、CD4＋、CD4＋／CD8＋、CDl6＋56值均较术前明显下降（P〈0．05），但M组下降的幅度较D组小（P〈0．05）；与D组比较，M组CD3＋、CD4＋、CD4＋／CD8＋、CDl6＋56值在T2和L时点明显增加（P〈0．05）。两组患者术后CD8＋均降低，但M组在T2、T3时点较D组CD8＋降低明显（P〈0．05）。M组在R时点TNF-α及IL-6水平较T1明显降低（P〈0．05），而D组无此差异。与D组比较，M组T2、T3时点TNF-α及IL-6水平明显降低（P〈O．05）。结论：右美托咪定可有效降低血清TNF-α和IL-6水平，抑制肺癌术后应激反应，改善患者免疫抑制状态。OBJECTIVE： To observe the changes of postoperative immune funαion in lung cancer patients after administration of dexmedetomidine in ICU, and to discuss its possible mechanism. METHODS： 48 ICU patients underwent endotracheal intuba- tion after general anesthesia radical reseαion for lung cancer were randomly divided into group D and group M. The patients of group M received dexmedetomidine 0.2-0.7 μg/（kg· h） by continuous intravenous pumping in ICU until the first morning after sur- gery; Ramsay score maintained in 3 or so. The patients of group D was given equal quantity of normal saline instead of dexmedeto- midine. Peripheral venous blood sample were taken in 2 groups respeαively in the morning of the day before the surgery （To）, im- mediate postoperative extubation （TI）, 24 h after the operation （T2） and 48 h after the operation （T3） for determination of absolute concentrations including total T lymphocytes （CD3＋）, Th cells （CD3＋ CD4＋）, Ts cells （CD3＋ CD8＋） and NK cells （CD16＋ 56）; ELISA was used to determine the serum level of TNF-α and IL-6. RESULTS： Compared with before operation, absolute con- centrations of CD3＋, CD4＋, CD4＋/CD8＋, CD16＋56 in 2 groups after operation were decreased significantly （P〈0.05） ; but the decrease of group M was lower than that of group D; compared with group D, the above concentrations of group M were increased significantly at T2 and T3 （P〈0.05）. CD8＋ count of 2 groups was decreased after operation, but the decrease of group M was more significant than group D at T2 and T3 （P〈0.05）. The levels of TNF-α and IL-6 in group M were decreased significantly at T3 （P〈 0.05） ; there was statistical significance （P〈0.05）. Those of group D had no significant difference. Compared with group D, the levels of TNF-α and IL-6 in group M were decreased significantly at T2, T3 （P〈0.05）. CONCLUSIONS： Dexmedetomidine can ef- feαively reduce the serum levels of TNF-α and IL-6 in lung can

关 键 词：右美托咪定 免疫功能 IL-6 TNF-Α 重症监护室 

分 类 号：R971.2[医药卫生—药品] R969.4[医药卫生—药学]