摘要
目的评价不同血浆靶浓度瑞芬太尼复合异丙酚对肺癌根治术病人细胞免疫功能的影响。方法择期肺癌根治术病人24例，ASAⅠ或Ⅱ级，年龄45～64岁，体重指数〈30kg／m^2。随机分为3组（n=8），麻醉诱导：R1组、R2组和R3组靶控输注瑞芬太尼，血浆靶浓度分别为4、6、8ng／ml，靶控输注异丙酚，血浆靶浓度为3μg／ml，待病人意识消失时静脉注射维库溴铵0．1mg／kg，3min后行气管插管，机械通气。各组术中瑞芬太尼血浆靶浓度维持不变，调整异丙酚血浆靶浓度维持脑电双频谱指数45—55，间断静脉注射维库溴铵0．05mg／kg维持肌松，术后均行病人自控静脉镇痛。于入室后5min（T0）、切皮后1h（T1）、术毕即刻（T2）、术后24h（T3）和术后72h（T4）抽取外周静脉血，采用流式细胞仪检测CD3^＋、CD4^＋、CD8^＋及NK细胞水平，计算CD4^＋／CD8^＋；采用ELISA法测定血清干扰素γ（IFN-γ）和白细胞介素4（IL-4）浓度，计算IFN-γ／IL-4。结果与T0时比较，R3组T2时血清IFN-γ浓度、IFN-γ／IL-4降低，R1组T1时血清IL-4浓度、T3，4时IFN-γ／IL-4降低，R1组、R2和R3组分别于T3、T2，3和T1-3，时CD3^＋细胞水平降低，R3组T1,2时CD8^＋、NK细胞水平降低（P〈0．05或0．01）；R3组T2时血清IFN-γ浓度、IFN-γ／IL-4较R1组和R2组降低（P〈0．05）；与R1组比较，R3组T1～3时CD3^＋、T1,2时CD8^＋、NK细胞水平降低（P〈0．05或0．01）；与R2组比较，R3组，T1,2时CD3^＋、NK细胞水平降低（P〈0．05或0．01）。结论靶控输注瑞芬太尼（血浆靶浓度8ng／ml）复合异丙酚（血浆靶浓度3μg／ml）可抑制肺癌根治术病人细胞免疫功能，但呈可逆性。
Objective To investigate the effects of different target plasma concentrations （CT） of remifentanil-propofol administered by TCI on cellular immune functions in patients undergoing lobectomy for lung cancer. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 45-64 yr undergoing lobectomy for lung cancer were randomly divided into 3 groups according to CT of remifentanil TCI. 4, 6 and 8 ng/ml （R1,2,3） （ n = 8 each）. ECG, BP, HR, SpO2 , PETCO2 and BIS were monitored during anesthesia. The patients were premedicated with iv atropine 0.5 mg. Anesthesia was induced with midazolam 0.05 mg/kg, propofol TCI （CT = 3 μg/ml） and TCI of remifentanil （CT = 4, 6 and 8 ng/ml in the 3 groups）. As soon as the patients lost consciousness, tracheal iutubation was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil during operation. CT of remifentanil was fixed at 4, 6 and 8 ng/ml respectively in the 3 groups. BIS was maintained at 45-55 by adjustment of CT of propofol. Venous blood samples were taken before anesthesia （ T0 ）, 1 h after skin incision （T1）, immediately （T2）, 24 and 48 h after the end of operation （T3,4） for determination of the expression of CD3^＋ , CD4^＋ , CD8^＋ on T ceils and CD16^＋ , CD56^＋ on natural killer cells （by flow cytometry） and serum concentrations of IFN-γ and IL-4 （ELISA）. Results The CD3^＋ T-lymphocytes were significantly decreased during and/or after operation as compared with the baseline at T0 in all 3 groups in a dose-dependent manner. The CD8^＋ T-lymphocytes and NK-cells were significantly decreased at T1,2 as compared with the baseline at T0 in group R3 and were lower than in group R1 . The serum IFN-γ concentration was significantly decreased at T2 in group R3 and was significantly lower than in group R1, 2. The serum IL-4 concentration was significantly decreased at T1 in group R1 . Conclusion Remifentani
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2008年第10期881-884,共4页
Chinese Journal of Anesthesiology
基金
河北省普通高等学校强势特色学科肿瘤学建设经费资助项目（2005-52）
关键词
哌啶类
二异丙酚
肺肿瘤
肺切除术
免疫
细胞
药物释放系统
Peperidines
Propofol
Pulmonary neoplasms
Pneumonectomy
Immunity, cellular
Drug delivery systems
