右美托咪定或丙泊酚全麻复合硬膜外麻醉对胃癌根治术老年患者免疫功能的影响

Effects of dexmedetomidine or propofol general anesthesia combined with epidural anesthesia on immune function in elderly patients undergoing radical operation for gastric cancer

目的评价右美托咪定或丙泊酚全麻复合胸段硬膜外麻醉对老年胃癌根治术患者围术期免疫功能的影响。方法择期行胃癌根治术患者50例,男26例,女24例,年龄65~75岁,ASAⅡ或Ⅲ级,术前未接受放化疗。采用随机数字表法将患者随机分为两组,每组25例。D组全麻诱导前10min静脉输注负荷量右美托咪定0.5μg/kg,术中以0.25μg·kg^(-1)·h^(-1)维持,C组静脉输注等量生理盐水。所有患者行T8~9或T9~10硬膜外穿刺置管及BIS监测。分别在麻醉诱导前30min和术后24h采集静脉血,测定T淋巴细胞亚群CD3^+、CD4^+、CD8^+、NK细胞水平。结果与麻醉诱导前30min比较,术后24hC组CD4^+、CD4^+/CD8^+、NK细胞水平明显降低(P<0.05),D组仅NK细胞水平明显降低(P<0.05)。术后24hD组CD4^+、CD4^+/CD8^+、NK细胞水平明显高于C组(P<0.05)。结论与单纯丙泊酚全麻复合硬膜外麻醉比较,右美托咪定减轻了老年胃癌根治术患者围术期免疫功能的抑制。

Objective To assess the effects of dexmedetomidine or propofol general anesthesia combined with thoracic epidural anesthesia on perioperative immune function in elderly patients undergoing radical operation for gastric cancer.Methods Fifty ASA Ⅱ orⅢ patients,aged 65-75 years,undergoing radical operation for gastric cancer,were randomly divided into 2 groups.No study patient received preoperative radiation or chemotherapy treatment.A loading dose of dexmedetomidine 0.5μg/kg was injected intravenously before induction,followed by infusion at 0.25μg·kg^（-1）·h^（-1） in group D.The equal volume of normal saline was administered in group C.All patients were placed a thoracic epidural catheter（T_8-T_9 or T_9-T_（10））and bispectral index monitoring.Venous blood was sampled 30 min before induction and 24 hpostoperation for measurement of the percentages of T lymphocyte subsets（CD3~＋,CD4~＋,CD8~＋）and NK cells by flowcytometry.Results Compared with that before induction,the levels of CD4~＋,CD4~＋/CD8~＋ratio and NK cells were significantly decreased after24 hoperation in group C（P〈0.05）.However,the level of only NK cells was significantly decreased after operation in group D（P〈0.05）.The levels of CD4~＋,CD4~＋/CD8~＋and NK cells in group D after operation were significantly higher than those in group C（P 0.05）.Conclusion Compared to only propofol intravenous general anesthesia,both dexmedetomidine and propofol combined with epidural anesthesia can reduce suppression on perioperative immune function for elderly patients undergoing radical operation of gastric cancer.