咪达唑仑、丙泊酚或右美托咪定全凭静脉麻醉对食管癌根治术患者围术期应激反应及细胞免疫功能的影响  

Effects of TIVA with midazolam,propofol or dexmedetomidine on surgical stress and cellular immune function in patients undergoing esophagectomy

作　　者：居刚[1] 蒋伟[1] 冯顺华[1] 葛志军[1] 韩超[1] 

机构地区：[1]江苏大学附属宜兴医院麻醉科,214200

出　　处：《江苏医药》2016年第6期663-665,共3页Jiangsu Medical Journal

基　　金：江苏大学临床医学科技发展基金(JLY20140070)

摘　　要：目的比较咪达唑仑、丙泊酚、右美托咪定全凭静脉麻醉(TIVA)对食管癌根治术患者围术期应激反应及细胞免疫功能的影响。方法食管癌根治术患者45例随机均分为三组,麻醉诱导和维持中分别采用咪达唑仑(M组)、丙泊酚(P组)或右美托咪定(D组)。于麻醉前(T0)、切皮后2h(T1)和术后24h(T2)采集外周静脉血,ELISA法检测血清C反应蛋白(CRP)和皮质醇(Cor)水平,流式细胞术检测T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)及自然杀伤(NK)细胞的水平,计算CD4^+/CD8^+比值。结果与T0时比较,T1时三组Cor、CRP增高,CD3^+、CD4^+、CD4^+/CD8^+比值及NK细胞水平均降低(P<0.05);T2时三组Cor和CRP增高,M组、P组CD4^+、CD4^+/CD8^+比值及NK细胞水平均降低(P<0.05)。T1时,P组和D组Cor和CRP低于M组,而CD3^+、CD4^+、CD4^+/CD8^+比值及NK细胞水平高于M组(P<0.05);T2时,D组Cor和CRP低于P组和M组,而CD4^+、CD4^+/CD8^+比值及NK细胞水平高于P组和M组(P<0.05)。结论食管癌根治术引起的应激反应能抑制围术期细胞免疫功能。右美托咪定能缓解手术应激引起的细胞免疫抑制,其效果可能强于咪达唑仑和丙泊酚。Objective To compare the effects of total intravenous anesthesia（TIVA）with midazolam,propofol or dexmedetomidine on surgical stress response and cellular immune function in the patients undergoing esophagectomy.Methods Forty-five patients scheduled for esophagectomy were anesthetized with TIVA,which was induced and maintained with midazolam（group M,15 cases）,propofol（group P,15 cases）or dexmedetomidine（group D,15 cases）.Venous blood samples were taken from peripheral vein before anesthesia（T0）,at 2hours after skin incision（T1）and 24 hours after surgery（T3）for the determinations of the expressions of CD3^＋,CD4^＋,CD8^＋on T cells and natural killer（NK）cells by flow cytometry,serum concentrations of cortisol（Cor）,C-reactive protein（CRP）by ELISA.The CD4^＋/CD8^＋ratio was calculated as well.Results Compared to T0,serum concentrations of Cor and CRP of three groups were significantly increased at T1,T2,and CD3^＋,CD4^＋,CD4^＋/CD8^＋ratio,NK cells of three groups were decreased at T1,while CD4^＋,CD4^＋/CD8^＋ratio,NK cells of groups of M and P were decreased at T2（P〈0.05）.At T1,the levels of Cor and CRP were lower,but CD3^＋,CD4^＋,CD4^＋/CD8^＋ratio and NK cells were higher,in groups of D and P than those in group M（P〈0.05）.At T2,the levels of Cor and CRP were lower,but CD3^＋,CD4^＋,CD4^＋/CD8^＋ratio and NK cells were higher,in group D than those in groups of M and P（P〈0.05）.Conclusion Surgical stress induced by esophagectomy can suppress celluar immune function,which may be attenuated more effectively by dexmedetomidine than midazolam and propofol.

关 键 词：咪达唑仑 丙泊酚 右美托咪定 应激反应 细胞免疫功能 

分 类 号：R614[医药卫生—麻醉学]