右美托咪定对舌癌患者围术期免疫功能的影响

Effect of Dexmedetomidine on the Immunological Status of Patients with Tongue Carcinoma

目的:探讨右美托咪定(Dex)对舌癌患者围术期免疫功能的影响。方法:将ASAⅠ～Ⅱ级拟行舌癌根治全麻择期手术患者30例随机分为右美托咪定组(Dex组)和对照组各15例。全麻诱导前,Dex组持续泵入右美托咪定0.5μg/kg(溶于10 mL生理盐水),对照组静脉持续泵入生理盐水10 mL,均在10 min内完成。以相同药物快速诱导插管,插管后Dex组以Dex、七氟醚、瑞芬太尼维持:对照组以七氟醚、瑞芬太尼维持。分别于T0(诱导前)、T1(切皮前,诱导后20 min)、T2(切皮后,诱导后50min)测定CD3^+、CD4^+、CD8^+、CD4^+/CD8^+及NK细胞比例。结果:两组在T0时间点CD3^+、CD4^+、CD8^+、CD4^+/CD8^+以及NK细胞的分布差异无统计学意义(P>0.05)。Dex组各个时间点CD3^+、CD4^+、CD8+、CD4^+/CD8^+及NK细胞变化不明显。相对于T0时间点,对照组T1、T2时间点CD3^+、CD4^+、CD4^+/CD8^+和NK细胞呈下降趋势,而CD8^+升高。和对照组比较,Dex组在T1、T2时间点CD4^+/CD8^+、NK细胞升高,而CD8^+降低。结论:Dex作为麻醉辅助药物能减轻全麻药物对舌癌患者免疫功能的影响。

Objective： To explore the effect of Dexmedetomidine （Dex） on the immunological status of patients with tongue carcinoma. Methods：30 patients with tongue carcinoma underwent surgery with general anesthesia （ASA Ⅰ～Ⅱ ） were included. Patiems were randomly divided into Dex group and control group, each n=15. The patients in the Dex group received 0.5 μg/kg of Dex before induction. After rapid induction and intubation, the Dex group was received Dex, sevofluran and remifentanil for maintenance and the control group received sevofluran and remifentanil instead. The CD3＋,CD4＋,CD8＋,CD4＋/CD8＋ and NK cell percentage were detected at 3 time points：T0 （before induction）, T1 （before skin incision, 20 rain after induction）, T2 （after skin incision, 50 rain after induction）. Results： The CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ and NK cells distribution had no significant differences at TO between the two groups （P〉0.05）. The CD3＋, CD4＋, NK cells percentage and CD4＋/CD8＋ decreased at T1,T2 when compared with TO in the control group, whereas CD8＋were increased. The CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ and NK cells did not change significantly in Dex group at each time point. The CD4＋/CD8＋ and NK cells percentage in Dex group at T1, T2 were higher than those in the control group. Conclusion： Dex as an anesthetic adjuvant, can decrease the suppression of immune status by general anesthetics in patients with tongue carcinoma.