右美托咪定对后路腰椎椎体间植骨融合术病人围术期炎症反应和细胞免疫功能的影响

Effects of dexmedetomidine on perioperative inflammatory response and cellular immune function inpatients undergoing posterior lumbar interbody fusion

目的评价右美托咪定对后路腰椎椎体间植骨融合术病人围术期炎症反应和细胞免疫功能的影响。 方法择期行后路腰椎椎体间植骨融合术的病人80例，性别不限，年龄40～60岁，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n＝40）：右美托咪定组（D组）和对照组（C组）。D组于麻醉诱导前10 min时静脉输注右美托咪定负荷量0.5 μg/kg，随后以0.5 μg·kg－1·h－1的速率输注至手术结束前15 min。分别于麻醉诱导前、手术开始30 min及术后1 h、1、3、5 d（T1-6）时抽取动脉血样，检测血浆CD42a＋/CD14＋比值、HLA-DR＋/CD14＋比值、C反应蛋白（CRP）浓度和白细胞计数。 结果与T1时比较，C组T2-6时CD42a＋/CD14＋比值升高，T3-6时HLA-DR＋/CD14＋比值降低，T4-6时血浆CRP浓度升高，T3-5时白细胞计数升高，D组T6时CD42a＋/CD14＋比值升高，T3-5时HLA-DR＋/CD14＋比值降低，T2-5时血浆CRP浓度升高（P〈0.05）。与C组比较，D组T2-4时CD42a＋/CD14＋比值降低，T4-5时HLA-DR＋/CD14＋比值升高，T2-5时血浆CRP浓度和白细胞计数降低（P〈0.05）。 结论右美托咪定可降低后路腰椎椎体间植骨融合术病人围术期炎症反应，改善细胞免疫功能。

Objective To evaluate the effects of dexmedetomidine on perioperative inflammatory response and cellular immune function in patients undergoing posterior lumbar interbody fusion. Methods Eighty American Society of Anesthesiologists physical status I or 11 patients of either sex, aged 40-60 yr, scheduled for elective posterior lumbar interbody fusion, were divided into dexmedetomidine group （ group Dex） and control group （group C） using a random number table with 40 patients in each group. In group D, dexmedetomidine at a loading dose of 0. 5 μg/kg was intravenously infused starting from 10 min before anesthesia induction, followed by continuous infusion of 0. 5 μg·kg-1·h-1 until 15 min before the end of operation. The equal volume of normal saline was given at the same time points in group C. Before induc- tion, at 30 min after beginning of operation and at 1 h and 1, 3 and 5 days after the end of operation （TI_6） , arterial blood samples were collected for determination of the plasma CD42a＋/CD14＋ ratio, HLA- DR＋/CD14＋ ratio, concentration of C-reactive protein （CRP） and white blood cell （WBC） count. Re- suits Compared with the baseline at T＋, the plasma CD42a＋/CD14＋ ratio was significantly increased at T2.6, the HLA-DR＋/CD14＋ ratio was decreased at T3.6, the plasma CRP concentrations were increased at T4.6, and the WBC count was increased at T3_5 in group C, and the plasma CD42a＋/CD14＋ ratio was signifi-cantly increased at T6, the HLA-DR＋/CD14＋ ratiowas decreased at T3_5, and the plasma CRP concentra- tions were increased at T2.5 in group D （P〈0. 05）. Compared with group C, the plasma CD42a＋/CD14＋ ratio was significantly decreased at T2.4, the HLA-DR＋/CD14＋ ratio was increased at T4_5, and the plasma CRP concentrations and WBC count were decreased at T2.5 in group D （P〈0. 05）. Conclusion Dexme- detomidine can decrease perioperative inflammatory response and improve cellular immune function in the patients undergoing posterior lumbar interbody fusion.