右美托咪定对心血管疾病手术患者围术期细胞免疫功能的影响

Influence of dexmedetomidinethe on perioperative cellular immune function during cardiovascular diseases

目的探讨右美托咪定在心血管麻醉中的应用对患者围术期细胞免疫功能的影响。方法选取75例择期行冠脉搭桥手术的冠心病患者为研究对象,根据术中右美托咪定用量,将其分为低剂量组(0.4μg/kg)、中剂量组(0.8μg/kg)、高剂量组(1.2μg/kg)。测定并比较3组患者术前、术后4、8、24 h镇痛评分、血流动力学指标、TNF-α、IL-2浓度、T淋巴细胞亚群变化情况。结果术后4、8 h,中、高剂量组患者镇痛评分、血流动力学指标明显优于低剂量组(P<0.05);术后4、8、24 h,中、高剂量组TNF-α、IL-2浓度均明显低于低剂量组(P<0.05),高剂量组显著低于中剂量组(P<0.05);术后8、24 h,中、高剂量组患者CD8+水平以及CD4^+/CD8^+比值均明显低于低剂量组(P<0.05)。结论心血管麻醉中,使用适当剂量的右美托咪定可缓解患者的疼痛程度、抑制炎症反应、改善患者围术期细胞免疫功能,值得在临床应用中广泛推广。

Objective To investigate the influence of dexmedetomidinethe on perioperative cellular immune function in cardiovascular anesthesia. Methods Seventy-five cases of coronary heart disease patients scheduled for coronary bypass surgery were selected as subjects. According to the dosage of dexmedetomidine, these patients were divided into the low dose group（0.4 μg/kg）, medium dose group（0.8 μg/kg）, and high dose group（1.2 μg/kg）. The changes of pain score, hemodynamic indexes, TNF-α, IL-2 and T lymphocyte subsets in the three groups were measured and compared before and after surgery. Results 4, 8 h after surgery, the pain score and hemodynamic index in medium and high dose groups were obviously better than those of the low dose group（P〈0.05）. At 4, 8, 24 h after surgery, the concentrations of TNF-α and IL-2 in medium and high dose groups were obviously better than those of the low dose group（P〈0.05）,and that of the high dose group was significantly lower than in the medium dose group（P〈0.05）. At 8, 24 h after surgery, the concentrations of CD8＋ and CD4＋/CD8＋in medium and high dose groups were obviously lower than those of the low dose group（P〈0.05）. Conclusion In cardiovascular anesthesia, an appropriate dose of dexmedetomidine can reduce the pain of patients, inhibit the inflammatory response and improve perioperative cellular immune function. This approach is worthy of widel application.