利多卡因复合硫酸镁静脉注射对全麻腹腔镜手术患者围手术期免疫应激的影响

Effect of intravenous infusion of lidocaine combined with magnesium sulfate on perioperative immunological stress in gener⁃al anesthesia patients undergoing laparoscopic surgery

目的评价利多卡因复合硫酸镁静脉注射对全麻腹腔镜手术患者围手术期免疫应激的影响。方法择期行全麻腹腔镜手术的患者76例,年龄18~65岁,美国麻醉医师协会分级Ⅰ、Ⅱ级,按随机数字表法分为两组(每组38例):对照组(C组)采用全凭静脉麻醉,试验组(L组)采用全凭静脉麻醉联合利多卡因复合硫酸镁静脉注射。记录两组患者一般资料(年龄、身高、体重、手术时间、麻醉时间),记录两组患者入室时(T_(1))、拔管后(T_(2))、术后2 d(T_(3))的CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、自然杀伤(NK)细胞、B细胞百分比及CD4^(+)/CD8^(+),酶联免疫吸附测定(ELISA)法检测两组患者血浆超敏C反应蛋白(hs-CRP)、γ-干扰素(IFN-γ)、前列腺素F2α(PGF2α)、前列腺素E2(PGE2)浓度,记录两组患者T_(3)时15项恢复质量量表(QoR-15)评分及术后住院时间。结果两组患者一般资料差异均无统计学意义(均P>0.05)。L组患者T_(3)时QoR-15评分高于C组(P<0.05),两组患者术后住院时间差异无统计学意义(P>0.05)。与T1时比较:C组患者T_(2)时CD3^(+)T细胞百分比、CD4^(+)T细胞百分比、CD4^(+)/CD8^(+)均降低(均P<0.05),NK细胞百分比升高(P<0.05);L组患者T2时NK细胞百分比升高(P<0.05),T_(3)时CD4^(+)T细胞百分比、B细胞百分比均升高(均P<0.05),NK细胞百分比降低(P<0.05)。与T_(2)时比较:两组患者T_(3)时CD3^(+)T细胞百分比、CD4^(+)T细胞百分比、B细胞百分比均升高(均P<0.05),NK细胞百分比降低(P<0.05),C组患者T_(3)时CD4^(+)/CD8^(+)升高(P<0.05)。与C组比较,L组患者T_(2)、T_(3)时CD4^(+)T细胞百分均较高,NK细胞百分均较低,T_(2)时CD3^(+)T细胞百分比较高(均P<0.05)。与T_(1)时比较,两组患者T_(3)时hs-CRP、IFN-γ浓度均升高(均P<0.05),L组患者T2时PGF2α、PGE2浓度均降低(均P<0.05);与T_(2)时比较,两组患者T3时hs-CRP、IFN-γ浓度均升高(均P<0.05),L组患者T_(3)时PGF2α、PGE2浓度均升高(均P<0.05)。与C组比较,L组患者T_(2)时PGF2α、PGE2浓度均较低(均P<0.05),T_(3)时hs-CRP、IFN-γ浓度均较低(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论利多卡因复合硫酸镁静脉注射可以减轻全麻腹腔镜手术患者的围手术期免疫应激,有利于患者术后恢复。

Objective To evaluate the effect of intravenous infusion of lidocaine combined with magnesium sulfate on periop⁃erative immunological stress in patients undergoing laparoscopic surgery with general anesthesia.Methods Seventy⁃six patients,aged 18-65 y,of the American Society of Anesthesiologists physical statusⅠorⅡ,undergoing laparoscopic surgery with general anes⁃thesia,were divided into 2 groups(n=38)according to the random number table mothod:experiment group(group L)and control group(group C).The group C received intravenous anesthesia only,while the group L received intravenous anesthesia combined with intrave⁃nous infusion of lidocaine combined with magnesium sulfate.Their general information were recorded(including age,height,weight,surgery time and anesthesia time);the percentages of CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,natural killer(NK)cells,B cells,and CD4^(+)/CD8^(+)at the time points of entry(T_(1)),after extubation(T_(2)),and 2 d after surgery(T_(3))for two groups of patients.Enzyme⁃linked immunosorbent assay(ELISA)was used to detect the concentrations of plasma high⁃sensitivity C⁃reactive protein(hs-CRP),interferon-γ(IFN-γ),prostaglandin F2(PGF2a),and prostaglandin E2(PGE2)in two groups of patients.The 15⁃item Quality of Recovery(OoR-15)score and postoperative hospital stay time were recorded.Results There was no statistical difference in general information between two groups(all P>0.05).The QoR-15 score at T_(3) in group L is higher than that in group C(P<0.05),while there is no significant differ⁃ence in postoperative hospital stay time between the two groups(P>0.05).Compared with the percentage at T_(1):the percentage of CD3^(+)T cells,CD4^(+)T cells,and CD4^(+)/CD8^(+)in group C decreased at T_(2)(all P<0.05),while the percentage of NK cells increased(P<0.05)at T_(2);the percentage of NK cells in group L increased(P<0.05)at T_(2) but decreased at T_(3)(P<0.05),the percentage of CD4^(+)T cells and B cells increased(all P<0.05)at T_(3).Compared with the percentages at T_(2):the percentages of CD3^(+)T cells,CD4^(+)T cells,and B cells in⁃creased in both groups at T_(3)(all P<0.05),the percentage of NK cells decreased(P<0.05);the percentage of CD4^(+)/CD8^(+)increased in group C at T_(3)(P<0.05).Compared with group C,group L had a higher percentage of CD4^(+)T cells but a lower percentage of NK cells at T_(2) and T_(3)(all P<0.05).Group L had a higher percentage of CD3^(+)T cells at T_(2) than the percentage in group C(all P<0.05).Compared with T_(1):the concentrations of hs⁃CRP and IFN⁃γincreased in both groups at T_(3)(all P<0.05),while the concentrations of PGF2αand PGE2 decreased in group L at T_(2)(all P<0.05).Compared with T_(2):the concentrations of hs⁃CRP and IFN⁃γincreased in both groups at T_(3)(all P<0.05),and the concentrations of PGF2αand PGE2 increased in group L at T_(3)(all P<0.05).Compared with group C:the con⁃centrations of PGF2αand PGE2 decreased in group L at T_(2)(all P<0.05),and the concentrations of hs⁃CRP and IFN-γ decreased in group L at T_(3)(P<0.05).There was no significant difference in other indexes between the two groups(all P>0.05).Conclusions Intra⁃venous infusion of lidocaine combined with magnesium can reduce perioperative immunological stress and benefit postoperative recov⁃ery in patients undergoing laparoscopic surgery with general anesthesia.