小剂量右美托咪定联合乌司他丁对肺癌患者免疫功能和应激反应的影响

目的: 观察小剂量右美托咪定联合乌司他丁对肺癌患者免疫功能和应激反应的影响。方法: 拟行肺癌手术的患者120例，随机分为A、B、C、D 4组，每组30例。麻醉诱导前，B组和D组静脉注射右美托咪定0.3 μg/kg，然后以0.3 μg·kg-1·h-1持续静脉输注至缝皮前，C组和D组静脉注射乌司他丁20万U，A组注射等剂量生理盐水。麻醉诱导前（T0）、手术结束时（T1）、手术结束后24 h（T2）取外周静脉血，测定CD3+、CD4+、CD4+/CD8+水平。记录T0、气管插管和拔管时的平均动脉压（MAP）和心率（HR）。记录术中七氟烷和瑞芬太尼用量及心动过缓、低血压和高血压的发生率。结果: CD3+、CD4+和CD4+/CD8+水平比较，A、B、C组T1和T2时点低于T0（P＜0.05），B、C组T1和T2时点高于A组（P＜0.05），D组T1和T2时点高于其他组（P＜0.05）。A、C组气管插管和拔管时的MAP和HR明显高于T0（P＜0.05），B、D组气管插管和拔管时的MAP和HR明显低于A、C组（P＜0.05）。B、D组术中七氟烷和瑞芬太尼用量和高血压发生率低于A、C组（P＜0.05）。结论: 小剂量右美托咪定联合乌司他丁用于肺癌患者，可改善患者围术期免疫抑制状态，抑制气管插管和拔管时的应激反应，减少术中麻醉药物使用。

Effects of low dose dexmedetomidine combined with ulinastatin on immune function and stress response in patients with lung cancer

AIM: To observe the effect of low dose dexmedetomidine combined with ulinastatin on immune function in patients with lung cancer. METHODS:A total of 120 patients with lung cancer scheduled to undergo operation were randomly divided into group A, B, C, D with 30 cases in each group. Before anesthesia induction, the patients in group B and group D received intravenous 0.3 μg·kg^-1·h^-1 dexmedetomidine after 0.3 μg/kg bolus. The patients in group C and group D received intravenous 200 000 U ulinastatin. The patients in group A received intravenous equal dose of saline. The levels of CD3+, CD4+, CD4+/CD8+ were determined before anesthesia (T0), 1 h after operation began (T1), 24 h (T2) after operation. The mean arterial pressure (MAP) and HR were also observed at T0, during tracheal intubation and extubation. The consumption of sevoflurane and remifentanil and the incident of bradycardia, hypotension and hypertension during operation were recorded. RESULTS:The levels of CD3+, CD4+ and CD4+/CD8+ of T1 and T2 were lower than those of T0 in group A, B and C (P＜0.05). At T1 and T2, the levels of CD3+, CD4+ and CD4+/CD8+ in group B and group C were higher than those in group A (P＜0.05), while those in group D were higher than those in other groups (P＜0.05). The MAP and HR of tracheal intubation and extubation were higher than those of T0 in group A and group C (P＜0.05). Compared with group A and group C, the MAP and HR of tracheal intubation and extubation were lower in group B and group D (P＜0.05). The consumption of sevoflurane and remifentanil and the incident of hypertension were lower in group B and group D than those in group A and group C (P＜0.05). CONCLUSION:Low dose dexmedetomidine combined with ulinastatin can improve perioperative immune function, inhibit stress response during tracheal intubation and extubation, and reduce the consumption of anesthetic drugs in patients with lung cancer.