發(fā)布時(shí)間：2019-04-13 12:43

【摘要】：目的探討右美托咪定對胸腔鏡下肺癌根治術(shù)患者圍術(shù)期免疫功能的影響。方法選取擇期行胸腔鏡下肺癌根治術(shù)的患者60例,性別不限,年齡18~73歲,美國麻醉醫(yī)師協(xié)會分級Ⅰ至Ⅲ級,隨機(jī)分入全身麻醉組和全身麻醉復(fù)合右美托咪定組(復(fù)合麻醉組),每組30例。麻醉誘導(dǎo)均采用丙泊酚、舒芬太尼、羅庫溴銨靜脈注射,雙腔支氣管插管后行機(jī)械通氣。復(fù)合麻醉組在麻醉誘導(dǎo)結(jié)束時(shí)將右美托咪定1μg/kg稀釋至20mL后在10min內(nèi)經(jīng)靜脈泵注射完畢。麻醉維持均以腦電雙頻指數(shù)40~60為目標(biāo)調(diào)整麻醉藥物用量。于手術(shù)前(T_0)、手術(shù)結(jié)束時(shí)(T_1)、手術(shù)后24h(T_2)3個時(shí)間點(diǎn),抽取外周靜脈血,檢測T淋巴細(xì)胞亞群(CD3~+、CD4~+、CD8~+、)、自然殺傷細(xì)胞(NK細(xì)胞)的比例和免疫球蛋白(IgA、IgG、IgM)水平。麻醉結(jié)束時(shí)記錄丙泊酚用量、舒芬太尼用量、術(shù)中補(bǔ)液量和手術(shù)時(shí)間。記錄術(shù)中特殊情況,隨訪患者術(shù)后不良反應(yīng)、并發(fā)癥和住院時(shí)間。結(jié)果全身麻醉組和復(fù)合麻醉組分別有6和2例患者術(shù)中快速冰凍切片病理學(xué)檢查顯示為良性病變,予以剔除。兩組患者的性別構(gòu)成、年齡、身高、體重、手術(shù)時(shí)間,以及術(shù)中補(bǔ)液量、舒芬太尼和丙泊酚用量的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。兩組在T_1和T_2時(shí)間點(diǎn)的CD3~+、CD4~+、NK細(xì)胞比例和IgA、IgG、IgM水平均顯著低于同組T0時(shí)間點(diǎn)(P值均0.05),兩組間各時(shí)間點(diǎn)CD3~+、CD4~+、CD8~+、NK細(xì)胞比例和IgA、IgG、IgM水平的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。兩組患者術(shù)中低血壓、心動過緩、惡心、嘔吐、術(shù)后肺部并發(fā)癥的發(fā)生率和住院時(shí)間的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論對于胸腔鏡下行肺癌根治術(shù)的患者,與單純?nèi)砺樽硐啾?全身麻醉復(fù)合右美托咪定對其免疫功能短時(shí)間內(nèi)無顯著影響。
[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.
【作者單位】： 上海交通大學(xué)附屬胸科醫(yī)院麻醉科;
【分類號】：R614;R734.2

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