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不同麻醉方式对胸腔镜下肺癌根治术患者围术期免疫功能的影响
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DOI:
作者:
赵政政,邱郁薇,鲁云纲 ,陈旭,李劲松,徐益萍, 朱宏伟 ,吴镜湘 ,徐美英
Zhengzheng Zhao, Yuwei Qiu, Yungang Lu, Xu Chen, Jinsong Li, Yiping Xu, Hongwei Zhu, Jingxiang Wu, Meiying Xu
作者单位:
上海交通大学附属胸科医院
Shanghai Chest Hospital, Shanghai Jiao Tong University
关键词:
胸腔镜手术;肺癌根治术;右美托咪定;免疫
thoracic surgery, Video-Assisted ; Pulmonary surgical procedures ; dexmedetomidine ; immunity
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,ASA分级≤Ⅲ级,随机分为全身麻醉组(G组,n=30)、全身麻醉复合右美托咪定组(GD组,n=30)。麻醉诱导均采用异丙酚、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。GD组于麻醉诱导结束时以右美托咪定1μg/kg的剂量10分钟泵注完毕。麻醉维持均以脑电双频谱指数(BIS)40~60为目标调整麻醉药物用量。分别于手术前(T0),手术结束时(T1),手术后24h(T2)抽取静脉血,检测T淋巴细胞亚群(CD3+、CD4+、CD8+、)、NK细胞的比例及免疫球蛋白(IgA、IgG、IgM)的水平。 结果:与T0相比,在T1、T2时刻,两组CD3+、CD4+、NK细胞比例以及IgA、IgG、IgM的水平均显著下降,差异具有统计学意义(P<0.05);然而两组间CD3+、CD4+、CD8+、NK、IgA、IgG、IgM的比较均无统计学差异(P>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。
Objective: This study was designed to investigated the effects of dexmedetomidine on perioperative immune functions in patients underwent radical resection of lung carcinoma by VATS Methods: 60 patients who received scheduled radical resection of lung carcinoma by VATS were involved in this study. They were aged from 18 to 75,accompany American Society of Anesthesiologists physical status Ⅰto Ⅲ. According to the study, patients were divided into two groups randomly. General anaesthesia(Group G, n=30), General anaesthesia combined with dexmedetomidine(Group GD, n=30). Patients were induced with propofol, sufentanil and rocuronium, after then, patients received double-lumen endobronchial intubation. Patients of group GD received dexmedetomidine 1μg/kg by continuous intravenous pumping at the end of induction. The anesthetic drugs were adjusted according to the bispectral index during the operation. Blood samples were taken at preoperative (T0), at the end of surgery (T1) and at 24h postoperative (T2)for analysis. The percentage of CD3+, CD4+, CD8+ T lymphocyte as well as the NK and the levels of IgA, IgG, IgM were detected. Results: When compared with T0 , the percentage of CD3+, CD4+T lymphocyte as well as the NK and the levels of IgA, IgG, IgM were decreased significantly at T1 and T2. However there’s no significant differences of these results among the two groups. Conclusion: For patients underwent thoracoscopic lung resection ,compared with general anesthesia, general anesthesia combined with dexmedetomidine had no significant effects on the immune functions perioperatively.
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