右美托咪啶对胸腔镜肺癌根治术患者围手术期炎症反应及细胞免疫功能的影响

Effect of dexmedetomidine on perioperative inflammatory response and cellular immune in patients undergoing radical operation of thoraeoscopic lung cancer

目的观察右美托咪啶对胸腔镜肺癌根治术患者围手术期炎症反应及免疫功能的影响。方法全麻单肺通气行胸腔镜肺癌根治术患者120例。随机分为右美托咪啶组（A组）和对照组（B组），每组60例。A组麻醉诱导前20min静注右美托咪啶负荷量1μ∥kg，15min输完，随后给予维持量0．5μg·kg^-1·h^-1，手术结束前20min时停药。B组相同方法输注等量生理盐水；在To（麻醉诱导前30min）、T1（完成手术时）、T2（手术后12h）、T3（手术后24h）时采集静脉血，用酶联免疫吸附试验（ELISA）测定血清肿瘤坏死因子-α（TNF-α）白细胞介素-6（IL-6）、白细胞介素一8（IL．8）的浓度；并在T0-T3分别测定CD；、cDf、CD；的表达水平和自然杀伤细胞（NK）细胞的含量，并依据数值计算CD；／CDs比值。结果与Tn相比，T0-T3时间点两组血清TNF-α、IL-α及IL-8的浓度升高，差异均有统计学意义（均P〈0．05）；CD3^＋、CD3^＋含量以及CD4^＋／CD8^＋比值、NK细胞水平均降低，差异均有统计学意义（均P〈0．05）。T1-T3时间点A组血清TNF-α、IL-6及IL-8的浓度较B组降低得更明显（均P〈0．05）。B组CD3^＋、CD4^＋含量以及CD4^＋／CD8^＋比值、NK细胞水平较A组降低得更显著（均P〈0．05）。结论右美托咪啶能减轻胸腔镜肺癌根治术患者围手术期的炎症反应，并且可以减少患者术后的免疫抑制。

Objective To evaluate the effect of dexemdetomidine on perioperative inflammatory response and cellular immune in patients undergoing radical operation of thoracoscopic lung cancer. Methods One hundred and twenty patients undergone radical operation of thoracoseopic lung cancer were randomly divided into control group （group B ） and dexemdetomidine group （group A） , 60 patients in each group. They were all implemented one-lung ventilation. In group A, dexmedetomidine at a loading dose of 1.0 μg/kg was intravenously infused starting from 20 min before anesthesia induction, followed by continuous infusion of 0. 5μg·kg ^-1 . h^-1 until 20 min before the end of operation. The equal volume of normal saline was given in group B. venous blood samples were collected for determination of the serum concentrations of TNF-α, IL-6 and IL-8. peripheral blood T-lymphocyte subsets（ CD3^＋ , CD^4＋ , CD8^＋ , CD^4＋/CD8^＋ ） and NK cell were also detected at 30 min before anesthesia induction （ TO ）, at the end of operation （ T~ ）, 12 h after operation（ T2 ） and 24 h after operation（T3 ）. Results Compared with the To, the plasma concentration of TNF-α ,IL-6 and IL-8 were increased（P 〈0. 05）. The levels of CD3^＋ and CD^4＋ , CD4^＋/CD8^＋ ratio and NK ceils were decreased in both groups at T1 - T3 （P 〈 0. 05 ） . Compared with group B, the plasma concentration of TNF-α , IL-6 and IL-8 were decreased more obviously in group A（P 〈 0. 05 ）. The levels of CD3^＋ and CD4^＋, CD^4＋/CD8^＋ ratio and NK cells were significantly increased in group A at T1 -T3 （P 〈 0. 05 ）. Conclusion Dexemdetomidine can decrease perioperative inflammatory response and improve cellular immune function in the patients undergoing radical operation of thoracoscopic lung cancer .