右美托咪定对肺癌根治术患者围术期氧化应激反应及细胞免疫功能的影响

Effect of dexmedetomidine on oxidative stress and cellular immune in patients undergoing radical operation of thoracoscopic lung cancer

目的:观察右美托咪定对胸腔镜肺癌根治术患者围术期氧化应激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100例;随机分为右美托咪定组(A组)和对照组(B组),每组50例。A组麻醉诱导前20 min静注右美托咪定负荷量1μg·kg^(-1),15 min输完,随后给予维持量0.5μg·kg^(-1)·h^(-1),手术结束前20 min时停药;B组相同方法输注等量生理盐水;在T_0(麻醉诱导前30 min)、T_1(完成手术时)、T_2(手术后12 h)、T_3(手术后24 h)时采集静脉血,检测丙二醛(MDA)浓度和超氧化物歧化酶(SOD)的水平,并分别测定CD_3^+、CD_4^+、CD_8^+的表达水平和NK细胞的含量,计算CD_4^+/CD_8^+比值。结果:与T_0相比,T_1-T_3时间点两组血清SOD活性降低,MDA浓度升高(P<0.05);CD_3^+、CD_4^+含量以及CD_4^+/CD_8^+比值、NK细胞水平均降低(P<0.05)。2组比较,T_1-T_3时间点A组血清SOD活性升高、MDA浓度降低得更明显(P<0.05)。B组CD_3^+、CD_4^+含量以及CD_4^+/CD_8^+比值、NK细胞水平降低得更显著(P<0.05)。结论:右美托咪定能够有效抑制围手术期诱发的应激反应,减轻胸腔镜肺癌根治术后患者的免疫抑制。

OBJECTIVE To investigate the effect of dexemdetomidine on oxidative stress and cellular immune in patients undergoing radical operation of thoracoscopic lung cancer.METHODS One hundred ASAⅠ–Ⅱpatients undergone radical operation of thoracoscopic lung cancer were randomly divided into two groups by using the random number table method：control group（group B）and dexemdetomidine group（group A）,50in each group.Patients all had one-lung ventilation.Patients in the group A received a loading dose of dexmedetomidine 1.0μg·kg-1 for 15 min,which was infused 20 minutes before anesthesia induction,and then dexmedetomidine was continuonsly infused,which was discontinued 20 min before surgeny at a rate of 0.5μg·kg-1·h-1.Patients in the group B were given the equal volume of saline.Venous blood samples were collected for determination of the serum concentrations of MDA and SOD,peripheral blood T-lymphocyte subsets（CD3＋,CD4＋,CD8＋,CD4＋/CD8＋）and NK cell were also detected 30 min before anesthesia induction（T0）,at the end of operation（T1）,12 h after operation（T2）and 24 h after operation（T3）.RESULTS Compared with T0,the activity of SOD was decreased and the plasma concentration of MDA was increased（P〈0.05）.The levels of CD3＋and CD4＋,CD4＋/CD8＋ratio and NK cells were decreased in both groups at T1-T3（P〈0.05）.The activity of SOD was increased and the plasma concentration of MDA was decreased more obviously in group A than group B（P〈0.05）.The levels of CD3＋and CD4＋,CD4＋/CD8＋ratio and NK cells were significantly increased in group A at T1-T3（P〈0.05）.CONCLUSION Dexemdetomidine can inhibit oxidative stress and improve the cellular immune function in patients undergoing radical operation of thoracoscopic lung cancer.