右美托咪定对肺癌患者胸腔镜术后认知、免疫炎性反应及氧化应激的影响  

Effect of dexmedetomidine on cognition, immune inflammatory reaction and oxidative stress in lung cancer patients with VATS

作　　者：刘静[1] 田玉红[1] 苗聪聪[2] Liu Jing;Tian Yuhong;Miao Congcong(Department of Anesthesiology,the Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China;Department of Clinical Laboratory,The Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China)

机构地区：[1]秦皇岛市第二医院麻醉科,河北省066600 [2]秦皇岛市第二医院检验科,河北省066600

出　　处：《中国基层医药》2019年第19期2371-2376,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨右美托咪定对胸腔镜肺癌切除术患者认知、淋巴细胞亚群、炎性因子及氧化应激水平的影响。方法选择2016年1月至2017年12月在秦皇岛市第二人民医院行胸腔镜肺癌手术的患者89例为研究对象,采用随机数字表法分为右美托咪定组(43例)及对照组(46例),比较两组在术前、术后6 h(T1)、12 h(T2)、24 h(T3)简易智力状态检测量表(MMSE)评分、淋巴细胞亚群、炎性因子及氧化应激水平的变化及MMSE的变化,并比较两组不良反应发生情况。结果对照组与右美托咪定组患者性别、年龄、体质量指数(BMI)、手术时间、麻醉时间差异均无统计学意义(均P>0.05);术后各个时间点,患者的MMSE评分较术前有所降低,右美托咪定组的MMSE评分高于对照组[(27.67±1.97)分比(25.61±1.81)分、(26.47±1.92)分比(24.70±2.26)分、(26.16±1.90)分比(23.41±2.33)分,t=-2.122、-2.553、-2.528,P=0.037、0.012、0.013]。两组患者激素水平、炎性因子水平、氧化应激情况、CD8淋巴细胞较术前均有所增加,右美托咪定组的炎性因子水平、激素水平及CD8淋巴细胞水平均低于同时间对照组的水平[白细胞介素6(IL-6):t=3.038、2.489、3.291,P=0.003、0.015、0.001;超敏C反应蛋白(hsCRP):t=2.147、2.164、2.752,P=0.035、0.033、0.007;肿瘤坏死因子α(TNF-α):t=2.119、2.323、2.485,P=0.037、0.023、0.015;丙二醛(MDA):t=2.499、2.116、2.094,P=0.014、0.037、0.039;髓过氧化物酶(MPO):t=2.190、2.166、2.849,P=0.031、0.033、0.005;超氧化物歧化酶(SOD):t=-2.551、-2.598、-3.141,P=0.012、0.011、0.002],右美托咪定组的不良反应较对照组有所减少(6/43比18/46,P=0.011)。结论在胸腔镜肺癌切除术的患者中,应用右美托咪定可以改善术后患者认知功能,减轻术后氧化应激反应,降低炎性反应,改善患者的免疫功能,减少不良反应。Objective To investigate the effect of dexmedetomidine on cognition (MMSE score), immune inflammatory reaction and oxidative stress in lung cancer patients with VATS. Methods From January 2016 to December 2017, 89 lung cancer patients underwent VATS in the Second Hospital of Qinhuangdao were randomly divided into the control group (n=46) and the dexmedetomidine group (n=43) according to the digital table.The MMES, CD4 and CD8 lymphocytes, inflammatory factors and oxidative stress factors were compared between the two groups before operation (T0) and at 3 hours (T1), 12 hours (T2), 24 hours (T3) after operation. Results There were no statistically significant differences in MMSE, CD4 and CD8 lymphocytes, inflammatory factors and oxidative stress factors between the two groups (P>0.05). At the time points of T1, T2 and T3, MMSE scores decreased in both two groups, but the MMSE score in the dexmedetomidine group was higher than those in the control group [(27.67±1.97)points vs.(25.61±1.81)points,(26.47±1.92)points vs.(24.70±2.26)points,(26.16±1.90)pouints vs.(23.41±2.33)points, t=-2.122,-2.553,-2.528, P=0.037, 0.012, 0.013]. The CD8 lymphocyte, inflammatory factors and oxidative stress factors increased after operation in both two groups, and dexmedetomidine could inhibit the increase of immune inflammatory factors and oxidative response factors(IL-6: t=3.038, 2.489, 3.291, P=0.003, 0.015, 0.001;hsCRP: t=2.147, 2.164, 2.752, P=0.035, 0.033, 0.007;TNF-α: t=2.119, 2.323, 2.485, P=0.037, 0.023, 0.015;MDA: t=2.499, 2.116, 2.094, P=0.014, 0.037, 0.039;MPO: t=2.190, 2.166, 2.849, P=0.031, 0.033, 0.005;SOD: t=-2.551,-2.598,-3.141, P=0.012, 0.011, 0.002). The incidence rate of adverse reactions in dexmedetomidine group was lower than that in control group(6/43 vs.18/46, P=0.011). Conclusion Dexmedetomidine can improve cognition, reduce immune inflammatory reaction and oxidative stress, and alleviate adverse effects in lung cancer patients with VATS.

关 键 词：肺肿瘤 胸腔镜检查 麻醉 认知 自身免疫 炎症 氧化性应激 右美托咪定 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]