不同浓度瑞芬太尼辅助麻醉对肺癌根治术患者围术期免疫功能的影响

Effects of different concentrations of remifentanil assistant anesthesia on perioperative immune function in patients undergoing radical resection of lung cancer

目的:观察不同靶浓度瑞芬太尼联合右美托咪定与丙泊酚等麻醉药物对胸腔镜下肺癌根治术患者围术期免疫功能的影响。方法:选择2013年8月至2016年10月在苏州大学附属张家港医院接受胸腔镜下肺癌根治术的患者110例,分为3组,术中分别给予4ng/mL、6ng/mL、8ng/mL的瑞芬太尼,均给予1μg/kg的右美托咪定。分别于术前、手术结束时、术后24h、术后72h检测血液中CD_3^+、CD_4^+、CD_8^+、NK细胞、lgG、lgA、lgM、干扰素(IFN)-γ、白细胞介素(IL)-4的水平,观察患者术后恢复时间。结果:3组术后恢复呼吸时间、恢复苏醒时间、插管时间比较,差异均无统计学意义(均P>0.05);与术前相比,Ⅰ组患者血清中CD_3^+、CD_4^+水平在术后24h显著降低(P<0.05),Ⅱ组患者血清中CD_3^+、CD_4^+、CD_8^+水平在手术结束时及术后24h均显著降低(均P<0.05),NK细胞水平在术后24h显著降低(P<0.05);Ⅰ组和Ⅱ组患者血清中lgG、lgA、lgM的水平均在术后24h显著降低(P<0.05);Ⅲ组患者血清中CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、NK细胞、lgG、lgA、lgM水平在手术结束时及术后24h均显著降低(均P<0.05);Ⅰ组和Ⅱ组患者血清中IFN-γ、IL-4水平在术前、后比较,差异无统计学意义(P>0.05);Ⅱ组患者IFN-γ/IL-4在术后24h及术后72h显著低于术前(均P<0.05),Ⅲ组患者血清中IFN-γ水平在手术结束时及术后24h显著低于术前(P<0.05),在手术结束时显著低于Ⅰ组和Ⅱ组(均P<0.05)。结论:8ng/mL的瑞芬太尼联合右美托咪定与丙泊酚等麻醉药物可抑制肺癌根治术患者围术期免疫功能,术后可自行恢复;4ng/mL、6ng/mL的瑞芬太尼对患者围术期免疫功能的影响较小。

Objective: To observe the effects of different concentrations of remifentanil assistant anesthesia on the perioperative immune function of patients undergoing thoracoscopic radical resection of lung cancer. Methods: A total of 110 patients underwent thoracoscopic lobectomy for lung cancer in our hospital from August 2013 to October 2016 were selected,and divided into three groups.4 ng/mL,6 ng/mL or 8 ng/mL remifentanil was given intraoperatively,and 1 μg/kg of metametramine was given as well.The levels of CD 3^+,CD 4^+,CD 8^+,NK cells,lgG,lgA,lgM,IFN-γ and IL-4 in the blood were measured before the operation,at the end of the operation,24 h after operation and 72 h after operation.The recovery time was recorded. Results: There was no significant difference in the recovery time and intubation time between the three groups (P >0.05).The levels of CD 3^+ and CD 4^+ at 24 post-operation in group I were decreased.The levels of CD 3^+,CD 4^+,and CD 8^+ in group Ⅱ were significantly decreased at the end of the operation and 24 h after operation,and the NK cells was reduced at 24 h after operation.(P<0.05).The levels of lgG,lgA and lgM in group I and group Ⅱ were significantly decreased at 24 h after operation (P<0.05).The levels of CD 3^+,CD 4^+,CD 8^+,CD 4^+/CD 8^+,NK,lgG,lgA and lgM in serum of group Ⅲ were significantly decreased at 0 h and 24 h after operation (P<0.05).The levels of IFN-γ and IL-4 in serum between group I and group Ⅱ were no obvious difference before and after operation (P >0.05).IFN-γ/IL-4 ratio in group Ⅱ was significantly lower at 24 h and 72 h after operation (P<0.05).The level of IFN-γ in serum of group Ⅲ was significantly decreased at 0 h and 24 h after operation,and it was lower than group I and group Ⅱ at the end of the operation (P<0.05). Conclusion: 8 ng/mL remifentanil combined with dexmedetomidine and propofol could inhibit perioperative immune function of patients with lung cancer,but 4 ng/mL and 6 ng/mL remifentanil had little effect on perioperative immune function of patients.