右美托咪定不同剂量对椎管内麻醉结肠癌患者免疫的动态影响

Dynamic effect of different doses of Dexmedetomidine on immune system in patients with colon cancer treated with intra-spinal canal anesthesia

目的探究右美托咪定不同剂量对椎内麻醉结肠癌患者免疫功能的动态影响。方法选择2011年8月至2013年10月于我院接受的结肠癌患者114例作为研究对象,均采取椎管内麻醉。随机分为3组,每组38例。A组为对照组,麻醉中注射等量生理盐水,B1组注射右美托咪定0.4μg·Kg/h^(-1),B2组给予右美托咪定0.8μg·Kg/h^(-1)。分别于麻醉前(T_0)、麻醉后1 h(T_1)、术毕(T_2)和术后24 h(T_3)四个时刻采集患者外周静脉血,利用流式细胞术手段测定T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)和NK细胞(CD16+CD56+)的百分比,取患者血液离心检测血清中细胞因子IL-2和IL-10的浓度。结果与T_0时刻相比,B1、B2组患者在T_1~T_3时刻CD3+、CD4+、CD8+、CD4+/CD8+、CD16+CD56+以及IL-2浓度均明显下降(P<0.05),IL-10浓度明显上升(P<0.05),A组、B1、B2组CD3+、CD4+、CD8+、CD4+/CD8+、CD16+CD56+及IL-2含量呈上升趋势,IL-10的浓度呈下降趋势。结论右美托咪定对椎管内麻醉结肠癌患者免疫功能有抑制效应,且抑制效应与剂量大小相关。

Objective To explore dexmedetomidine given the dynamic effects of different doses on the immune vertebral anesthesia patients with colon cancer. Methods 114 cases of colon cancer patients in our hospital from August 2011 to October 2013 were selected for the study, all the patients were taken spinal anesthesia. They were divided into three groups according to random number table method, 38 cases in each group. Group A was given saline anesthesia as the control group, group B1 were injected with dexmedetomidine 0.4μg·kg-1·h-1, group B2 were injected with dexmedetomidine 0.8μg·kg-1·h-1. Peripheral venous blood sample of each group were collected before anesthesia （To）, after anesthesia lh （TI）, right after surgery （T2）, and 24 h after surgery （T3） seperately, then detected T lymphocyte subsets （CD3＋, CD4＋, CD8＋, CD4＋/ CD8＋） and NK cells （CD16＋ CD56＋）by flow cytometry instruments, whichever the patient＇s blood Sample was centrifuged to detected the concentration of cytokines IL-2 and IL-10 in serum. Results Compared with T0, CD3＋, CD4＋, CD8＋, CD4＋/ CD8＋, CD16＋ CD56＋ and IL-2 concentrations of group B1 ,B2 in T1-T3 moment were significantly decreased （P〈0.05）, IL-10 was significantly increased （P〈0.05） ;compared to group A, the value of CD3＋, CD4＋, CD8＋, CD4＋/ CD8＋, CD16＋CD56＋ and IL-2 group B1, B2 were on the rise, but the concentration of IL-10 decreased. Conclusion Dexmedetomidine given in spinal anesthesia can inhibit the immune function of patients with colon cancer, and the effect of inhibition will become more obvious with the increasing of dose.