右美托咪定预处理对老年肺癌根治术后舒芬太尼静脉自控镇痛时患者细胞免疫功能的影响

Effects of dexmedetomidine pretreatment on cellular immune function during aged patient-controlled intravenous analgesia with sufentanil after radical surgery of lung cancer

目的评价右美托咪定预处理对老年肺癌根治术后舒芬太尼静脉自控镇痛时患者细胞免疫功能的影响。方法择期行肺癌根治术患者60例,ASA分级Ⅰ~Ⅱ,年龄65~73岁,随机分为两组,每组30例。右美托咪定组（D组）术前予以右美托咪定0.5μg·kg-1泵注,对照组（C组）给予氯化钠注射液,两组麻醉诱导及维持方法相同,术后均予舒芬太尼静脉自控镇痛。记录术后视觉模拟量表评分（VAS）及患者自控静脉镇痛（PCIA）泵按压次数。检测给药前（T0）、划皮后1 h（T1）、术毕（T2）、术后1 d（T3）和术后3 d（T4）患者T淋巴细胞亚群水平。结果与C组相比,D组术后4、12、24、48、72 h五个时间点的VAS均降低,术后0~24 h、〉24~48 h、〉48~72 h PCIA泵按压次数减少,差异均有显著意义（P〈0.05）。与T0时相比,C组T3时CD3＋、CD4＋和CD4＋/CD8＋明显降低（P〈0.05）。与C组相比,D组T3时CD3＋、CD4＋和CD4＋/CD8＋细胞水平升高（P〈0.05）。右美托咪定组和对照组不良反应发生率无显著差异（23%vs.17%,P〉0.05）。结论右美托咪定预处理可增强术后镇痛效果,改善老年肺癌根治术后舒芬太尼静脉自控镇痛时患者细胞免疫功能。

AIM To evaluate the effects of dexmedetomidine on cellular immune function during aged patient-controlled intravenous analgesia with sufentanil after radical surgery of lung cancer. METHODS Sixty patients aged 65 - 73 years old people undergone lung cancer randomized into two groups, with 30 patients in each group. The group C received intravenous injection of sodium chloride before anesthesia. The group D received injection of dexmedetomidine 0.5 μg·kg-1 in 10 minutes. All patients had same analgesia induction and maintain, and were received patient controlled intravenous analgesia （PCIA） with sufentanil after operation. The cervical venous blood samples were obtained from the patients at To （before pretreatment of dexmedetomidine）, T1 （ 1 h of operation）, T2 （immediately of operation end）, T3 （ 1 d after operation）, and T4 （3 d after operation） for determination of the expression of CD3＋, CD4＋, CD8＋ lymphocytes. The analgesia effects were assessed by visual analogue scales （VAS） and the number of PCIA pressing times was recorded. The adverse reactions were observed. RESULTS Compared with the group C, the VAS of the group D at d, 12, 24, 48 , 72 h after operation were decreased （P 〈 0.05） . The number of PCIA pressing times during 0-24 h, 〉 24-48 h, 〉 48-72 h after operation were significantly lower in the group D than those in the group C （P 〈 0.05）. Compared with To, the expression of CD3＋ lymphocytes, CD4＋ lymphocytes and CDa＋/CD8~ of the group C were markedly decreased at T3 （P 〈 0.05）. Compared with the group C, the expression of CD3＋ lymphocytes, CD4~ lymphocytes, CDa＋/CD8＋ of the group D was increased at T3 （P 〈 0.05）. There were no significant differences in adverse reactions incidence between the group D and group C （23% vs. 17%, P 〉 0.05）. CONCLUSION Dexmedetomidine pretreatment can improve analgesic effect and cellular immune function during aged patient-controlled intravenous analgesia with sufentanil after radical surgery of lung cancer.