右美托咪定对胸腔镜下肺癌根治术患者围术期免疫功能的影响  

Effects of dexmedetomidine on perioperative immune function in patients undergoing radical resection of lung carcinoma by video-assisted thoracic surgery

作　　者：赵政政[1] 邱郁薇[1] 鲁云纲[1] 陈旭[1] 李劲松[1] 徐益萍[1] 朱宏伟[1] 吴镜湘[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200030

出　　处：《上海医学》2015年第12期882-885,共4页Shanghai Medical Journal

摘　　要：目的探讨右美托咪定对胸腔镜下肺癌根治术患者围术期免疫功能的影响。方法选取择期行胸腔镜下肺癌根治术的患者60例,性别不限,年龄18~73岁,美国麻醉医师协会分级Ⅰ至Ⅲ级,随机分入全身麻醉组和全身麻醉复合右美托咪定组(复合麻醉组),每组30例。麻醉诱导均采用丙泊酚、舒芬太尼、罗库溴铵静脉注射,双腔支气管插管后行机械通气。复合麻醉组在麻醉诱导结束时将右美托咪定1μg/kg稀释至20mL后在10min内经静脉泵注射完毕。麻醉维持均以脑电双频指数40~60为目标调整麻醉药物用量。于手术前(T_0)、手术结束时(T_1)、手术后24h(T_2)3个时间点,抽取外周静脉血,检测T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、)、自然杀伤细胞(NK细胞)的比例和免疫球蛋白(IgA、IgG、IgM)水平。麻醉结束时记录丙泊酚用量、舒芬太尼用量、术中补液量和手术时间。记录术中特殊情况,随访患者术后不良反应、并发症和住院时间。结果全身麻醉组和复合麻醉组分别有6和2例患者术中快速冰冻切片病理学检查显示为良性病变,予以剔除。两组患者的性别构成、年龄、身高、体重、手术时间,以及术中补液量、舒芬太尼和丙泊酚用量的差异均无统计学意义(P值均>0.05)。两组在T_1和T_2时间点的CD3^+、CD4^+、NK细胞比例和IgA、IgG、IgM水平均显著低于同组T0时间点(P值均<0.05),两组间各时间点CD3^+、CD4^+、CD8^+、NK细胞比例和IgA、IgG、IgM水平的差异均无统计学意义(P值均>0.05)。两组患者术中低血压、心动过缓、恶心、呕吐、术后肺部并发症的发生率和住院时间的差异均无统计学意义(P值均>0.05)。结论对于胸腔镜下行肺癌根治术的患者,与单纯全身麻醉相比,全身麻醉复合右美托咪定对其免疫功能短时间内无显著影响。Objective To investigate the effect of dexmedetomidine on perioperative immune function in patients undergoing radical resection of lung carcinoma by video-assisted thoracic surgery （VATS）. Methods Sixty patients, aged from 18 to 75 years, American Society of Anesthesidogists（ASA） physical status Ⅰ to Ⅲ, scheduled for radical resection of lung carcinoma by video-assisted thoracic surgery were enrolled in this study. They were randomly divided into two groups （n = 30） = general anesthesia group and general anesthesia combined with dexmedetomidine group （combined anesthesia group）. Propofol, sufentanil and rocuronium were applied for the induction of anesthesia in all patients. Mechanical ventilation was performed after double-lumen endobronchial intubation. Dexmedetomidine 1 μg/kg diluted to 20 mL was given by venous pump within 10 min at the end of induction in the combined anesthesia group. The doses of anesthetics were adjusted according to the bispectral index （40 - 60） during the operation. Peripheral venous blood samples were taken before surgery （To）, at the end of the surgery （T1） and at 24 h after surgery （T2）. The percentage of CD3＋ , CD4＋ , CD8＋ T lymphocytes as well as natural killer （NK） cells and the levels of immunoglobulin A, G, M （IgA, IgG, IgM） were detected. The infusion of propofol, sufentanil and fluid, operation time and special circumstances during the operation were recorded. Postoperative adverse reactions, complications and time of hospitalization were also recorded. Results Six patients of general anesthesia group and two patients of combined anesthesia group were excluded because the results of intraoperative frozen section were benign. There were no significant differences in terms of gender, age, height, weight, operation time, fluid infusion, the consumption of propofol or sufentanil between the two groups （all P〉0. 05）. When compared with those at To, the percentages of CD3＋ , CD4＋ T lymphocytes, NK cells and the levels of

关 键 词：胸腔镜手术 肺癌根治术 右美托咪定 免疫 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]