右美托咪定对肺癌患者血流动力学及免疫功能的影响

Effect of Dexmedetomidine on Hemodynamics and Immune Function of Patients with Lung Cancer

目的观察右美托咪定对肺癌患者血流动力学及免疫功能的影响。方法选择2016年1月至2017年6月上海市第八人民医院收治的62例肺癌患者为研究对象,根据诱导方案不同将患者分为对照组和观察组,各31例。两组患者均行全身麻醉,观察组泵注右美托咪定0.8μg/kg,时间10 min,对照组静脉注射咪达唑仑0.05 mg/kg,然后两组均静脉注射等剂量长托宁、芬太尼、丙泊酚、顺-阿曲库铵,意识丧失、肌肉松弛满意后插入双腔支气管导管,均泵注丙泊酚及间断静注芬太尼及顺-阿曲库胺维持麻醉深度。比较两组不同时点间平均动脉压(MAP)、心率变化,并测定不同时点间T细胞亚群数量评估免疫功能变化,统计两组术中不良反应发生情况。结果对照组术中1 h心率高于切皮时,两组患者诱导前MAP、心率均小于插管即刻,随后逐渐降低;两组患者术中1 h、手术结束即刻、术后24 h、术后48的自然杀伤细胞、CD_4^+、CD_4^+/CD_8^+呈递减趋势,CD+8呈递增趋势;上述指标两组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.01)。观察组术中1例低血压,对照组出现2例高血压,经处理均好转,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论右美托咪定应用于肺癌根治术有助于维持血流动力学稳定,且改善免疫功能,应用安全。

Objective To observe dexmedetomidine on hemodynamic and immune function of patients with lung cancer.Methods From Jan.2016 to Jun.2017,62 cases of lung cancer admitted to Shanghai Eighth People′s Hospital were selected as the study subjects.The patients were divided into a control group and an observation group according to different induction scheme,31 cases each.Both groups were given general anesthesia.The induction program for the observation group was:pumping dexmedetomidine 0.8 g/kg,for 10 min;the control group was injected with midazolam,0.05 mg/kg,and then both groups were injected with penehyclidine hydrochloride,fentanyl,propofol and cisatracurium of the same dose till loss of consciousness and satisfied muscle relaxation,then propofol was pumped and intermittent static injection of fentanyl and cisatra curium was given to maintain anesthetic depth.The mean arterial pressure(MAP),heart rate changes at different time points were compared,and the T cell subgroup quantity was measured to assess the immune function change,and the adverse reactions were recorded.Results Except that the heart rate of the control group at intraoperative 1 h was higher than at the skin incision,the MAP and heart rate of both groups before induction were lower than those at the intubation point,which then declined gradually;NK,CD+4,CD+4/CD+8 levels at intraoperative 1 h,operation end,postoperative 24 h,postoperative 48 h of both groups declined,while the CD+8 level was in an uptrend;the above indicators of the two groups had statistically significant differences between groups,time points and group time interactions(all P<0.01).There was 1 case of hypotension in the observation group and 2 cases of hypertension in the control group,all of which relieved after treatment,and there was statistically significant difference in the adverse reaction rate between the two groups(P>0.05).Conclusion Dexmedetomidine applied in lung cancer operation helps to maintain stable hemodynamics,which can also improve immune function with good safety.