右美托咪定对需单侧肺通气的肺癌根治术患者术中应激反应和术后免疫功能的影响

Effects of dexmedetomidine on intraoperative stress response and postoperative immune function in patients undergoing radical lung cancer surgery requiring unilateral lung ventilation

目的探讨右美托咪定对需单侧肺通气的肺癌根治术患者术中应激反应和术后免疫功能的影响。方法选取2018年6月至2020年3月该院收治的118例需单侧肺通气的肺癌根治术患者为研究对象,按随机数字表法分为观察组和对照组,每组59例。对照组患者采取常规麻醉诱导与维持,观察组患者在对照组的基础上在术前给予右美托咪定0.5μg/kg静脉滴注。比较两组麻醉诱导前(T0)、切皮时(T1)、切除癌变组织时(T2)、手术结束时(T3)的心率(HR)、平均动脉压(MAP)、血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、肾上腺素(E)水平;比较两组T0、术后6 h(T4)、术后24 h(T5)、术后48 h(T6)的T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))和血清白细胞介素-6(IL-6)水平。结果两组T0时间点的HR、MAP、Cor、ATCH、NE、E、IL-6及T淋巴细胞亚群水平比较,差异无统计学意义(P>0.05)。T1、T2、T3时间点,对照组HR、MAP、Cor、ATCH、NE、E水平明显高于观察组,差异有统计学意义(P<0.05)。观察组T4、T5、T6时间点的血清IL-6水平低于对照组,差异有统计学意义(P<0.05)。观察组T4、T5、T6时间点的CD8^(+)水平明显低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平明显高于对照组,差异有统计学意义(P<0.05)。结论在需单侧肺通气的肺癌患者进行肺癌根治术前使用右美托咪定能高选择性激动α2受体,有助于减轻术中应激反应,降低术后炎症反应水平,调节患者免疫功能,从而改善患者预后。

Objective To explore effects of dexmedetomidine on intraoperative stress response and postoperative immune function in patients undergoing radical lung cancer surgery requiring unilateral lung ventilation.Methods From June 2018 to March 2020,a total of 118 patients undergoing radical lung cancer surgery requiring unilateral lung ventilation were selected as the research objects.According to the random number table method,they were divided into observation group and control group,with 59 cases in each group.The control group was given routine anesthesia induction and maintenance,and the observation group was given dexmedetomidine 0.5μg/kg intravenous drip before surgery on the basis of the control group.The heart rate(HR),mean arterial pressure(MAP),serum cortisol(Cor),adrenocorticotropic hormone(ACTH),norepinephrine(NE),epinephrine(E)levels were compared between the two groups before anesthesia induction(T0),at the time of skin incision(T1),when the cancerous tissue was removed(T2),and at the end of the surgery(T3).T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and serum interleukin-6(IL-6)levels were compared between the two groups at T0,6 h after surgery(T4),24 h after surgery(T5)and 48 h after surgery(T6).Results There was no significant difference on HR,MAP,Cor,ATCH,NE,E,IL-6 and T lymphocyte subsets between the two groups at T0 time point(P>0.05).At T1,T2 and T3 time points,the levels of HR,MAP,Cor,ATCH,NE and E in the control group were significantly higher than those in the observation group,and the differences were statistically significant(P<0.05).The serum IL-6 levels in the observation group at T4,T5 and T6 time points were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of CD8^(+)at T4,T5 and T6 time points in the observation group were significantly lower than those in the control group,and the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Dexmedetomidine can highly selectively stimulateα2 receptors in lung cancer patients requiring unilateral lung ventilation before radical lung cancer surgery.It helps to reduce the intraoperative stress response,reduce the level of postoperative inflammatory response,and regulate the immune function of patients,thereby improving the prognosis of patients.