右美托咪定对脊柱结核患者术后细胞免疫功能的影响

发布时间：2018-05-07 09:25

本文选题：右美托咪定 + 结核　；参考：《临床麻醉学杂志》2015年11期

【摘要】：目的观察右美托咪定对脊柱结核患者术后细胞免疫功能的影响。方法 40例行择期脊柱结核病灶清除加植骨内固定融合术患者,随机均分为右美托咪定组(D组)和对照组(C组)。D组于麻醉诱导前10min内静脉泵注右美托咪定0.5μg/kg,然后行麻醉诱导插管,同时以右美托咪定0.3μg·kg-1·h-1维持至手术结束前40min,术后以0.8μg/kg行患者自控静脉镇痛;C组静脉泵注等容生理盐水。于麻醉诱导前20min(T0)、术后4h(T1)、术后24h(T2)及术后48h(T3)监测外周血血糖、皮质醇、T淋巴细胞亚群CD3+、CD4+、CD8+、自然杀伤(NK)细胞及IL-2、IL-10水平,并计算CD4+/CD8+比值。记录T1~T3时疼痛VAS和镇静Ramsay评分。结果 T1时两组患者血糖及皮质醇浓度均高于T0时(P0.05),但D组明显低于C组(P0.05);T1时两组CD3+、CD4+和CD4+/CD8+明显低于T0时,且C组明显低于D组(P0.05);T2、T3时D组CD3+、CD4+、和CD4+/CD8+明显高于C组(P0.05);T1时两组NK水平明显高于T0时,且D组明显高于C组(P0.05);C组在T1、T2时IL-2浓度明显低于,T2、T3时IL-10浓度明显高于T0时和D组(P0.05)。结论右美托咪定应用于脊柱结核的围手术期,可以减少手术创伤的应激反应,减轻术后免疫功能的抑制。
[Abstract]:Objective to observe the effect of dexmetomidine on cellular immune function in patients with spinal tuberculosis after operation. Methods 40 patients with selective spinal tuberculosis were treated with excision and fusion of bone graft and internal fixation. They were randomly divided into dexmetomidine group (group D) and control group (group C). Group D was given dexmetomidine 0.5 渭 g / kg intravenously before anesthesia induction, and then intubated by anesthesia induction. At the same time, dexmetomidine 0.3 渭 g kg-1 h-1 was maintained until 40 minutes before the end of operation. Postoperative patient-controlled intravenous analgesia was performed with 0.8 渭 g/kg. Group C received intravenous infusion of isovolumic saline. The levels of blood glucose, CD3 T lymphocyte subsets, CD3 CD4 and CD8, and IL-2IL-10 were measured 20 minutes before anesthesia induction, 4 hours after anesthesia, 24 hours after operation, 24 hours after operation and 48 hours after operation. The ratio of CD4 / CD8 was calculated. Pain VAS and sedative Ramsay score were recorded during T1~T3. Results the concentrations of blood glucose and cortisol in both groups at T1 were higher than those at T0, but the levels of CD3 CD4 and CD4 / CD8 in group D were significantly lower than those in group C at T 1, and that in group C was significantly lower than that in group D (P 0.05) and T 2 + T 3 (P < 0.05), and the level of CD3 CD4 in group D was significantly lower than that in group D at T 1 (P 0.05) and T 2 + T 3 (P < 0.05). The level of NK in group D was significantly higher than that in group T _ 0, and the concentration of IL-2 in group D was significantly higher than that in group C at T _ 1 and T _ 2 compared with that in group T _ 2 and group D was significantly higher than that in group T _ 0 and group D respectively at T _ (1) T _ 2 and T _ (2) T _ (3). Conclusion the perioperative application of dexmetidine in spinal tuberculosis can reduce the stress response of surgical trauma and relieve the inhibition of postoperative immune function.
【作者单位】：南京中医药大学附属南京市中西医结合医院麻醉科;南京医科大学第一附属医院麻醉科;南京中医药大学附属南京市中西医结合医院骨科;
【分类号】：R614

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