不同剂量右美托咪定对老年肺癌根治术患者免疫功能及苏醒期应激反应的影响

Effect of Different Doses of Dexmedetomidine on Immune Function and Stress Response in the Recovery Period of Radical Operation of Elderly Patients with Lung Cancer

目的探讨不同剂量右美托咪定对老年肺癌根治术患者的免疫功能及苏醒期应激反应的影响。方法选择2012年10月至2014年10月解放军第一八一医院收治的132例择期行肺癌根治术的老年患者为研究对象,将所有患者采用随机数字表法分为A、B、C三组,各44例。A组患者麻醉中采用0.5μg/kg的右美托咪定,B组患者采用1μg/kg的右美托咪定,C组患者采用15 m L生理盐水静脉注射。观察三组患者麻醉前(T_1)、气管拔管时(T_2)及气管拔管5 min时(T_3)的心率、收缩压、舒张压以及血糖、血清肾上腺素的水平,同时记录三组患者麻醉前(T_1)、麻醉结束时(T_4)、术后12 h(T_5)及术后24 h(T_6)的T淋巴细胞亚群以及自然杀伤细胞等免疫功能指标的水平进行检测。结果三组患者的心率、血压均先升高后降低,其中T_2时B组患者的收缩压显著高于A组,T_2时C组患者的心率、收缩压、舒张压均显著高于A、B组,T_3时C组患者的收缩压也显著高于A、B组,差异均有统计学意义(P<0.05);而B组患者T_2时肾上腺素水平显著高于A组,而T_3时血糖及肾上腺素均显著高于A组,同时C组患者T_2、T_3时的血糖及肾上腺素均显著高于A、B两组,差异均有统计学意义(P<0.05);T4时B组患者的CD_3^+、CD_4^+/CD_8^+及CD_(16)^+_(56)^+水平均显著低于A组,T_5时B组患者的所有指标及T_6时的CD_3^+、CD_4^+、CD_8^+、CD_(16)^+_(56)^+均显著高于A组,差异均有统计学意义(P<0.05);而C组患者T_4时CD_3^+、CD_4^+、CD_4^+/CD_8^+、CD_(16)^+_(56)^+均显著高于A、B两组,T_5时CD_3^+、CD_4^+、CD_(16)^+_(56)^+高于A、B两组,CD_8^+高于A组,而CD_4^+/CD_8^+明显高于B组,T_6时CD_3^+、CD_4^+、CD_8^+显著高于A、B两组,CD_(16)^+_(56)^+高于B组,差异均有统计学意义(P<0.05)。结论小剂量的右美托咪定能更好地抑制老年肺癌根治术患者的苏醒期应激反应,但是对患者的免疫功能也具有一定的抑制作用,具有一定的剂量依赖性。

Objective To investigate the influence of different doses of dexmedetomidine effect on the stress response of the immune function of the patients and recovery period in radical operation on lung cancer in the elderly. Methods Total of 132 elderly patients of lung cancer for elective radical operation were chosen in Chinese PLA 181 st Hospital from Oct. 2012 to Oct. 2014,all patients were divided into A,B,C three groups of 44 cases according to random number table method： 0. 5 μg / kg dexmedetomidine was used during operation in group A,1 μg / kg of dexmedetomidine was used in group B,the same dose of normal saline was used in group C. The heart rate,systolic pressure,diastolic pressure and the level of blood glucose,serum epinephrine of the three groups at before anesthesia（ T1）,extubation（ T2）,5 min after extubation（ T3） were detected,and the T lymphocyte subsets and NK cells and other immune level indexes of the three groups were recorded at T1,end of anesthesia（ T4）,12 h postoperative（ T5） and 24 h postoperative（ T6）. Results Heart rate and blood pressure of the three groups increased first and then decreased,at T2 SBP of group B was significantly higher than group A,HR,SBP and DBP of group C were significantly higher than group A and group B,at T3 SBP of group C was significantly higher than group A and group B,the differences were statistically significant（ P 〈 0. 05）; at T2 adrenaline of group B was significantly higher than group A,at T3 blood glucose and adrenaline of group C were significantly higher than group A and B,the differences were statistically significant（ P 〈 0. 05）; at T4 B CD3＋CD4＋/ CD8＋and CD16＋56＋levels of group B were significantly lower than group A,at T5 all the indexes and at T6CD3＋,CD4＋,the CD8＋,CD16＋56＋of group B were significantly higher than group A,the differences were statistically significant（ P 〈 0. 05）;while at T4CD3＋,CD4＋,CD4＋/ CD8＋,CD16＋56＋of group C were significantly higher than that of group A and B,at T5CD3＋,CD4＋,CD16＋56＋of group C were significantly higher than group A and B,CD8＋was significantly higher than group A,while CD4＋/ CD8＋was higher than group B,at T6CD3＋,CD4＋,CD8＋were significantly higher than group A and B,CD16＋56＋was significantly higher than group B,the differences were statistically significant（ P 〈 0. 05）. Conclusion A small dose of dexmedetomidine can better inhibit stress response in recovery period of radical operation for elderly patients with lung cancer,but also has a certain inhibitory effect on the immune function of patients,with a certain dose-dependency.