不同剂量右美托咪定混合罗哌卡因超声引导下TPVB联合全身麻醉对胸腔镜下肺癌根治术患者应激反应、免疫功能和微转移的影响

Effects of Different Doses of Dexmedetomidine Mix with Ropivacaine Ultrasound-Guided TPVB Combine with General Anesthesia on Stress Response,Immune Function and Micrometastasis in Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

目的:探讨0.5μg/kg、1.0μg/kg、1.5μg/kg三种剂量的右美托咪定混合罗哌卡因超声引导下胸椎旁神经阻滞(TPVB)联合全身麻醉对胸腔镜下肺癌根治术患者应激反应、免疫功能和微转移的影响。方法:选取我院132例行胸腔镜下肺癌根治术的患者,根据随机数字表法将132例患者随机分为高剂量组(1.5μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB,44例)、中剂量组(1.0μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB,44例)和低剂量组(0.5μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB,44例)。对比三组苏醒质量、血流动力学[心率(HR)、收缩压(SBP)、舒张压(DBP)]、应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]、免疫功能[CD3^(+)、CD4^(+)、CD8^(+),计算CD4^(+)/CD8^(+)]、微转移[表皮生长因子受体信使核糖核酸(EGFR mRNA)、肺特异性X蛋白(LUNX mRNA)、细胞角蛋白19(CK19 mRNA)]、不良反应发生率。结果:低剂量组、中剂量组、高剂量组的苏醒时间、气管拔管时间、恢复室停留时间依次延长(P<0.05)。低剂量组、中剂量组、高剂量组气管拔管时(T2)、气管拔管5 min时(T3)时间点HR、SBP、DBP依次升高(P<0.05)。低剂量组、中剂量组、高剂量组术后48 h E、NE、Cor依次升高(P<0.05)。低剂量组、中剂量组、高剂量组术后48 h CD8^(+)依次升高,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)依次下降(P<0.05)三组术后48 h EGFR mRNA、LUNX mRNA、CK19 mRNA下降,但各组间无显著性差异。三组不良反应发生率组间对比未见差异(P>0.05)。结论:右美托咪定联合罗哌卡因超声引导下TPVB可有效控制胸腔镜下肺癌根治术患者应激反应,维持血流动力学稳定,减轻免疫抑制,改善微转移,以0.5μg/kg的剂量效果最佳。

Objective:To investigate the effects of 0.5μg/kg,1.0μg/kg,1.5μg/kg three doses of dexmedetomidine mix with ropivacaine ultrasound-guided thoracic paravertebral nerve block(TPVB)combine with general anesthesia on stress response,immune function and micrometastasis in patients undergoing thoracoscopic radical resection of lung cancer.Methods:132 patients undergoing thoracoscopic radical resection of lung cancer in our hospital were selected,and patients were divided into high dose group(1.5μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB,44 cases),middle dose group(1.0μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB,44 cases)and low dose group(0.5μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB,44 cases)according to the random number table.The recovery quality,hemodynamics[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)],stress response indexes[epinephrine(E),norepinephrine(NE),cortisol(Cor)],immune function[CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)],micrometastasis[epidermal growth factor receptor messenger ribonucleic acid(EGFR mRNA),lung specific X protein(LUNX mRNA),cytokeratin 19(CK19 mRNA)]and incidence of adverse reactions were compared in three groups.Results:The recovery time,tracheal extubation time and recovery room stay time in low dose group,middle dose group and high dose group were prolonged in turn(P<0.05).HR,SBP and DBP in low dose group,middle dose group and high dose group increased in turn at the time of tracheal extubation(T2)and 5 min after tracheal extubation(T3)(P<0.05).The levels of E,NE and Cor in low dose group,middle dose group and high dose group increased in turn at 48h after operation(P<0.05).CD8^(+)in low dose group,middle dose group and high dose group increased in turn,while CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)decreased in turn at 48 h after operation(P<0.05).EGFR mRNA,LUNX mRNA,and CK19 mRNA decreased at 48 h after surgery in the three groups,but there was no significant difference between the three groups.There was no difference in the incidence of adverse reactions in three groups(P>0.05).Conclusion:Dexmedetomidine combine with ropivacaine ultrasound-guided TPVB can effectively control the stress response of patients undergoing thoracoscopic radical resection of lung cancer,maintain hemodynamic fluctuations,reduce immunosuppression,and improve micrometastasis,the dose of 0.5μg/kg is the best.