右美托咪定对胸腔镜下肺癌根治术患者围术期免疫功能的影响

发布时间：2019-04-13 12:43

【摘要】：目的探讨右美托咪定对胸腔镜下肺癌根治术患者围术期免疫功能的影响。方法选取择期行胸腔镜下肺癌根治术的患者60例,性别不限,年龄18~73岁,美国麻醉医师协会分级Ⅰ至Ⅲ级,随机分入全身麻醉组和全身麻醉复合右美托咪定组(复合麻醉组),每组30例。麻醉诱导均采用丙泊酚、舒芬太尼、罗库溴铵静脉注射,双腔支气管插管后行机械通气。复合麻醉组在麻醉诱导结束时将右美托咪定1μg/kg稀释至20mL后在10min内经静脉泵注射完毕。麻醉维持均以脑电双频指数40~60为目标调整麻醉药物用量。于手术前(T_0)、手术结束时(T_1)、手术后24h(T_2)3个时间点,抽取外周静脉血,检测T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、)、自然杀伤细胞(NK细胞)的比例和免疫球蛋白(IgA、IgG、IgM)水平。麻醉结束时记录丙泊酚用量、舒芬太尼用量、术中补液量和手术时间。记录术中特殊情况,随访患者术后不良反应、并发症和住院时间。结果全身麻醉组和复合麻醉组分别有6和2例患者术中快速冰冻切片病理学检查显示为良性病变,予以剔除。两组患者的性别构成、年龄、身高、体重、手术时间,以及术中补液量、舒芬太尼和丙泊酚用量的差异均无统计学意义(P值均0.05)。两组在T_1和T_2时间点的CD3~+、CD4~+、NK细胞比例和IgA、IgG、IgM水平均显著低于同组T0时间点(P值均0.05),两组间各时间点CD3~+、CD4~+、CD8~+、NK细胞比例和IgA、IgG、IgM水平的差异均无统计学意义(P值均0.05)。两组患者术中低血压、心动过缓、恶心、呕吐、术后肺部并发症的发生率和住院时间的差异均无统计学意义(P值均0.05)。结论对于胸腔镜下行肺癌根治术的患者,与单纯全身麻醉相比,全身麻醉复合右美托咪定对其免疫功能短时间内无显著影响。
[Abstract]:Objective to investigate the effect of right metomidine on perioperative immune function in patients undergoing thoracoscopic radical resection of lung cancer. Methods 60 patients undergoing thoracoscopic radical resection of lung cancer were randomly divided into two groups: general anesthesia group (n = 60) and general anesthesia combined with right metomidin group (n = 18), aged 18 to 73 years old. The patients were randomly divided into two groups: general anesthesia group and general anesthesia combined with right metomidine group (compound anesthesia group). There were 30 cases in each group. Propofol, sufentanil and rocuronium were injected intravenously, and mechanical ventilation was performed after double lumen bronchial intubation. In the combined anesthesia group, right metomidine 1 渭 g / kg was diluted to 20mL at the end of anesthesia induction and then injected into 10min by intravenous pump. Anesthesia maintenance was aimed at EEG bispectral index (40? 60) to adjust the dosage of narcotic drugs. Peripheral venous blood samples were taken to detect T lymphocyte subsets (CD3~, CD4~, CD8~,) at 3 time points before operation (T0), at the end of the operation (T), and 24 h after the operation (T 2). The proportion of natural killer cells (NK cells) and the level of immunoglobulin (IgA,IgG,IgM). Propofol dosage, sufentanil dosage, intraoperative infusion volume and operation time were recorded at the end of anesthesia. The postoperative adverse reactions, complications and hospital stay were recorded. Results 6 patients in general anesthesia group and 2 patients in combined anesthesia group were diagnosed as benign lesions by rapid frozen section. There was no significant difference in sex composition, age, height, weight, operation time, volume of rehydration and dosage of sufentanil and propofol between the two groups (P < 0.05). The percentage of CD3~, CD4~, NK cells and IgA,IgG,IgM in the two groups were significantly lower than those in the same group at the time point of T0 (P0.05). The ratio of CD3~, CD4~, CD8~, NK and IgA,IgG, at each time point between the two groups was significantly lower than that at the time point of T0 in the same group. There was no significant difference in the level of IgM between the two groups (P < 0.05). There was no significant difference in the incidence of hypotension, bradycardia, nausea, vomiting, postoperative pulmonary complications and hospital stay between the two groups (P 0.05). Conclusion compared with general anesthesia, general anesthesia combined with right metomidine has no significant effect on immune function in patients undergoing thoracoscopic radical resection of lung cancer.
【作者单位】：上海交通大学附属胸科医院麻醉科;
【分类号】：R614;R734.2

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