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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 thoracoscopic radical resection of lung cancer. Methods Sixty patients undergoing thoracoscopic radical resection of lung cancer undergoing elective surgery were enrolled in this study. Their gender, age ranged from 18 to 73 years. American Society of Anesthesiologists graded Ⅰ to Ⅲ were randomly divided into general anesthesia group and general anesthesia combined with dexmedetomidine Group (compound anesthesia group), 30 cases in each group. Induction of anesthesia were used propofol, sufentanil, rocuronium intravenous injection, double lumen bronchial catheterization after mechanical ventilation. Compound anesthesia group at the end of anesthesia, dexmedetomidine 1μg / kg diluted to 20mL within 10min after intravenous injection is completed. Anesthesia are maintained to adjust the target amount of narcotic drugs for the EEG dual frequency index 40 ~ 60. Peripheral venous blood was collected at T0, T_1, and 24h after T_2, and T lymphocyte subsets (CD3 ~ +, CD4 ~ +, CD8 ~ +, , Natural killer (NK) cells and immunoglobulin (IgA, IgG, IgM) levels. At the end of anesthesia, the dosage of propofol, sufentanil dosage, intraoperative fluid volume and operation time were recorded. The special cases were recorded and the patients were followed up for adverse reactions, complications and length of stay. Results In the general anesthesia group and the compound anesthesia group, 6 and 2 cases of intraoperative fast frozen section pathological examination showed benign lesions, to be removed. The gender composition, age, height, weight, operation time, intraoperative fluid volume, sufentanil and propofol dosage were not significantly different between the two groups (P> 0.05). The levels of CD3 +, CD4 +, NK cells and the levels of IgA, IgG and IgM at T_1 and T_2 were significantly lower than those in the same group at T0 (all P <0.05). At each time point There was no significant difference in the proportion of CD3 ~ +, CD4 ~ +, CD8 ~ +, NK cells and IgA, IgG and IgM (P> 0.05). Hypotension, bradycardia, nausea, vomiting, postoperative pulmonary complications and length of hospital stay were not significantly different between the two groups (P> 0.05). Conclusion For patients undergoing thoracoscopic surgery for radical resection of lung cancer, the combination of general anesthesia with dexmedetomidine has no significant effect on immune function in a short period of time compared with that of simple general anesthesia.