右美托咪定联合利多卡因对颅脑肿瘤手术患者炎性因子、氧化应激和免疫功能的影响

Effects of dexmedetomidine combined with lidocaine on inflammatory response,oxidative stress and immune function in patients with craniocerebral tumor after surgery

目的观察右美托咪定联合利多卡因对颅脑肿瘤手术患者炎性因子、氧化应激和免疫功能的影响。方法选择神经外科择期行首次颅内幕上肿瘤切除术患者80例,随机分为对照组(CON组)、利多卡因组(LIDO组)、右美托咪定组(DEX组)和右美托咪定联合利多卡因组(DEX^+LIDO组),每组20例。比较2组术前24 h、术后24 h应激激素[肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)]、炎性因子[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C-反应蛋白(hs-CRP)]、氧化应激指标[丙二醛(MDA)、总抗氧化态(TAS)]、T淋巴细胞亚群(CD^+4、CD^+8、CD^+4/CD^+8)。结果4组术前24 h E、NE、DA、IL-6、TNF-α、hs-CRP、MDA、TAS、CD^+4、CD^+8、CD^+4/CD^+8比较差异无统计学意义(P>0.05),DEX组、DEX^+LIDO组术后24 h E、NE、DA、IL-6、TNF-α、hs-CRP、MDA、CD^+8均低于CON组、LIDO组,TAS、CD^+4、CD^+4/CD^+8均高于CON组、LIDO组(P<0.05),且DEX^+LIDO组E、NE、DA、IL-6、TNF-α、hs-CRP、MDA、CD^+8低于DEX组,TAS、CD^+4、CD^+4/CD^+8高于DEX组(P<0.05)。结论颅脑肿瘤手术中应用右美托咪定联合利多卡因能够有效抑制患者术后炎性反应和氧化应激,并改善患者细胞免疫功能。

Objective To investigate the effects of dexmedetomidine combined with lidocaine on inflammatory response,oxidative stress and immune function in patients with craniocerebral tumor after surgery.Methods Eighty patients with craniocerebral tumors who underwent surgical treatment were enrolled in this study,who were randomly divided into control group(CON group),lidocaine group(LIDO group),dexmedetomidine(DEX group)and DEX^+LIDO group,with 20 cases in each group.The levels of stress hormones(E,NE and DA),inflammatory cytokines(IL-6,TNF-αand hs-CRP),oxidative stress indexes(MDA and TAS),and T lymophocytes subtypes(CD^+4,CD^+8 and CD^+4/CD^+8)were observed and compared among the four groups.Results At 24h before the operation,there were no significant differences in levels of E,NE,DA,IL-6,TNF-α,hs-CRP,MDA,TAS,CD^+4,CD^+8 and CD^+4/CD^+8 amoong the four groups(P>0.05).However the levels of E,NE,DA,IL-6,TNF-α,hs-CRP,MDA and CD^+8 in DEX group and DEX^+LIDO group were significantly lower than those in CON group and LIDO group at 24h after the operation,but the levels of TAS,CD^+4 and CD^+4/CD^+8 in DEX group and DEX^+LIDO group were significantly higher than those in CON group and LIDO group(P<0.05).Moreover the levels of E,NE,DA,IL-6,TNF-α,hs-CRP,MDA and CD^+8 in DEX^+LIDO group were significantly lower than those in the DEX group,and the levels of TAS,CD^+4 and CD^+4/CD^+8 in DEX^+LIDO group were significantly higher than those in DEX group(P<0.05).Conclusion The anesthetic pretreatment by dexmedetomidine combined with lidocaine can effectively alleviate the inflammatory reaction and oxidative stress response,and improve the immune function of patients with craniocerebral tumor after surgery.