右美托咪定对结肠癌根治术患者围术期应激反应及细胞免疫功能的影响

Effect of dexmedetomidine on stress response and cellular immune function in patients undergoing radical resection of colon cancer

目的:探讨右美托咪定对结肠癌根治术患者围术期应激反应及细胞免疫功能的影响。方法:择期行结肠癌根治术患者96例,采用数字表法随机均分为右美托咪定组(D组)和对照组(C组)。D组气管插管后静脉泵注右美托咪定0.6μg/kg,随后以0.3μg/(kg·h)的速率静脉输注至术毕,C组给予等容量和速率的0.9%生理盐水。分别于麻醉诱导前10 min(T_0)、术毕即刻(T_1)、术后24 h(T_2)和术后72 h(T_3)采集患者静脉血,采用流式细胞仪检测T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)及NK细胞的百分比,并测定去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、IL-6、IL-10及TNF-α水平。记录患者T_0、插管即刻(T_a)、T_1、拔管即刻(T_b)的SBP、DBP、MAP及术后不良反应发生情况。结果:T_a、T_1、T_b时C组SBP、DBP及MAP明显高于T_0时和D组(P<0.05)。T_1、T_2时两组CD3^+、CD4^+、CD8^+及CD4^+/CD8明显低于T_0时(P<0.05),且T_1、T_2、T_3时C组CD3^+、CD4^+、CD8^+及CD4^+/CD8明显低于D组(P<0.05)。T_1、T_2时C组NK细胞明显低于T_0时和D组(P<0.05)。T_1、T_2时两组IL-6、IL-10及TNF-α水平明显高于T_0时(P<0.05),且C组明显高于D组(P<0.05);T_3时C组IL-6及IL-10水平明显高于T_0时和D组(P<0.05)。T_1、T_2时两组NE、E及Cor水平明显高于T_0时(P<0.05),且C组明显高于D组(P<0.05)。T_3时C组NE、E及Cor水平明显高于T_0时和D组(P<0.05)。D组发生不良反应的比例明显低于C组(χ2=4.800,P=0.028)。结论:右美托咪定可抑制结肠癌根治术患者围术期的应激反应,降低对免疫功能的影响。

Objective：To investigate the effect of dexmedetomidine on stress response and cellular immune function in patients undergoing radical resection of colon cancer during perioperative period.Methods：96 cases of colon cancer undergoing radical resection were randomly divided into dexmedetomidine group（group D） and control group（group C）.The group D was intubated with intravenous infusion of dexmedetomidine 0.6 μg/kg,followed by intravenous infusion of 0.3 μg/（kg·h） at the end of the surgery,and the group C was given 0.9% saline at equal volume and rate.The venous blood of patients was collected before anesthesia induction,10 min（T_0）,immediate postoperative（T_1）,postoperative 24 h（T_2） and postoperative 72 h（T_3）.Flow cytometry were used to detect T lymphocyte subsets（CD3~＋,CD4~＋,CD8~＋,CD4~＋/CD8~＋） and the percentage of NK cells,and determination of norepinephrine（NE）,epinephrine（E）,cortisol（Cor）,IL-6,IL-10 and TNF-α levels.Records of patients with T_0,immediate intubation（Ta）,T_1,immediate extubation（Tb） of SBP,DBP,MAP,and postoperative adverse reactions were recorded.Results：The SBP,DBP and MAP of group C at Ta,T_1,Tb were significantly higher than that of T_0 and group D（P0.05）.Compared to those at T_0,the levels of CD3~＋,CD4~＋,CD8~＋and CD4~＋/CD8 at T_1 and T_2 were significantly lower in both groups（P0.05）,and the levels of group C at T_1,T_2,T_3 were significantly lower than those in group D（P0.05）.The NK cells of group C at T_1,T_2 were significantly lower than that of T_0 and group D（P0.05）.Compared to those at T_0,the levels of IL-6,IL-10 and TNF-α at T_1 and T_2 were significantly higher in both groups（P0.05）,and the levels in group C were significantly higher than those in group D（P0.05）.The IL-6 and IL-10 of group C at T_3 were significantly higher than that of T_0 and group D（P0.05）.Compared to those at T_0,the levels of NE,E and Cor at T_1 and T_2 were significantly higher in both groups（P0.05）,and the levels in group C were significantly higher than those in group D（P0.05）.The NE,E and Cor of group C at T_3 were significantly higher than that of T_0 and group D（P0.05）.The proportion of adverse reactions in group D was significantly lower than that in group C（χ~2=4.800,P=0.028）.Conclusion：Dexmedetomidine can inhibit the perioperative stress response and reduce the impact on immune function in patients undergoing radical resection of colon cancer.