右美托咪定对胃癌手术患者免疫状况的影响

Effect of dexmedetomidine on the immune function of patients with gastric carcinoma

目的探讨右美托咪定对胃癌手术患者免疫状况的影响。方法选取2015年5月至2015年10月行胃癌手术的患者80例,采用随机数表法将其随机分成两组:对照组(n=40)和右美托咪定组(n=40)。在麻醉诱导之后,对右美托咪定组患者按0.5μg/kg静脉注射右美托咪定10 min,之后按0.4μg·kg-1·h-1注射右美托咪定至手术结束;对对照组患者静脉注射等量的生理盐水。记录手术过程中两组患者的生命体征、手术前后C反应蛋白(CPR)值、血糖值。于麻醉诱导前、手术结束时(T0)、手术后24 h(T1)、手术后72 h(T2)抽取患者外周静脉血,测定其血CD3、CD4、CD8、NK细胞的含量以及血浆IL-2、IL-10、IFN-γ的浓度,计算出CD4/CD8值。结果与麻醉诱导前相比,术后两组患者的CPR值与血糖值均明显上升(P﹤0.05),其中右美托咪定组的上升幅度较小;术后两组患者T0时刻的CD3、CD4、CD8细胞含量均减少(P﹤0.05),其中右美托咪定组的减少幅度较小;两组患者的NK细胞浓度均上升,其中右美托咪定组的上升幅度较大(P﹤0.05);T1、T2时刻,右美托咪定组患者血浆IL-2、IFN–γ浓度与对照组相比较高,IL-10浓度与对照组相比较低(P﹤0.05)。结论右美托咪定能够减轻胃癌患者对手术创伤的应激反应,改善其围术期免疫状况。

Objective To investigate the effects of dexmedetomidine on the immune function of patients with gastric carcinoma. Method 80 patients with gastric cancer were enrolled in the study, and were randomized into control group （n=40） or study group （n=40） as per a random number table. After induction of anesthesia, the patients in study group were given 0.5μg/kg dexmedetomidine i.v. for 10 min, then maintained at 0.4μg＆#183; kg-1＆#183; h-1 to the end of surgery;While pa-tients in control group were given intravenous injection of saline with similar regimen. Vital signs like C-reactive protein and blood glucose levels before and after surgery were recorded;Peripheral venous blood were collected before induction of anesthesia, at the end of surgery （T0）, 24 hours after surgery （T1）, and 72 hours after surgery （T2） to determine the lev-el of CD3, CD4, CD8, NK in blood and the concentration of IL-2, IL-10, and IFN-γin plasma, and then the ratio of CD4/CD8 was calculated. Result The CPR and blood glucose level in both groups were significantly increased at T0 as compared with those before induction of anesthesia （P〈0.05）, and a relatively minor increase was observed in the study group;The levels of CD3, CD4, and CD8 at T0 in both groups were consistently decreased （P 〈0.05）, while less change was ob-served in the study group;While at T1 and T2, the concentration of IL-2 and IFN-γwere higher, but IL-10 was lower in study group compared with those of control group （P〈0.05）;The level of NK cells was significantly increased in both groups, and the study group had obviously higher rise （P〈0.05）;While at T1 and T2 time, the concentration of IL-2 and IFN-γ were higher, but IL-10 was lower in study group compared with those of control group （P 〈0.05）. Conclusion Dexmedetomidine reduces surgical trauma stress, and improves the perioperative immune function in patients with gastric cancer.