摘要
目的观察右美托咪定对脊柱结核患者术后细胞免疫功能的影响。方法 40例行择期脊柱结核病灶清除加植骨内固定融合术患者,随机均分为右美托咪定组（D组）和对照组（C组）。D组于麻醉诱导前10min内静脉泵注右美托咪定0.5μg/kg,然后行麻醉诱导插管,同时以右美托咪定0.3μg·kg^-1·h^-1维持至手术结束前40min,术后以0.8μg/kg行患者自控静脉镇痛;C组静脉泵注等容生理盐水。于麻醉诱导前20min（T0）、术后4h（T1）、术后24h（T2）及术后48h（T3）监测外周血血糖、皮质醇、T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、自然杀伤（NK）细胞及IL-2、IL-10水平,并计算CD4^＋/CD8^＋比值。记录T1~T3时疼痛VAS和镇静Ramsay评分。结果 T1时两组患者血糖及皮质醇浓度均高于T0时（P〈0.05）,但D组明显低于C组（P〈0.05）;T1时两组CD3^＋、CD4^＋和CD4^＋/CD8^＋明显低于T0时,且C组明显低于D组（P〈0.05）;T2、T3时D组CD3^＋、CD4^＋、和CD4^＋/CD8^＋明显高于C组（P〈0.05）;T1时两组NK水平明显高于T0时,且D组明显高于C组（P〈0.05）;C组在T1、T2时IL-2浓度明显低于,T2、T3时IL-10浓度明显高于T0时和D组（P〈0.05）。结论右美托咪定应用于脊柱结核的围手术期,可以减少手术创伤的应激反应,减轻术后免疫功能的抑制。
Objective To observe the effects of dexmedetomidine on postoperative cellular im- mune function in patients undergoing spinal tuberculosis surgery. Methods Forty spinal tuberculosis patients were randomly divided into two groups： dexmedetomidine group （group D, n=20） and con- trol group （group C, n=20）. The patients in group D were intravenously infused with 0. 5 μg/kg dexmedetomidine in 10 minutes before induction of anesthesia and intubation, and subsequently main- tained with 0. 3 μg·kg^-1·h^-1 dexmedetomidine until 40 minutes before the end of the operation. Af- ter operation, postoperative patient-controlled intravenous analgesia （PCIA） with 0. 8 μg/kg dexme- detomidine was given. The patients in group C were injected intravenously with isometric saline in- stead. Peripheral blood samples were taken 20 min before induction of anesthesia （To）, 4 hours after operation （T1）, 24 hours after operation （T2） and 48 hours after operation （T3）. Blood glucose, ser- um cortisol, T-lymphocyte subsets （CD3^＋、CD4^＋ , CD8^＋ ）, NK cells, the levels of IL-2 and IL-10 were detected, and the ratio of CD4^＋/CD8^＋ were calculated. We also recorded the pain VAS and se- dation Ramsay scores at T1-T3. Results The blood glucose and cortisol significantly increased in both groups at T1 （P〈0. 05） , however the increase was more significant in group C than that in group D （P〈0. 05）. Compared with T0＂, CD3^＋、CD4^＋ and CD4^＋/CD8^＋ in both groups were decreased at T1 （P〈0. 05）, which was more significant in group C than that in group D （P〈0.05）. At T2and Tar CD3^＋, CD4^＋, and CD4^＋/CD8^＋ in group D increased significantly, which was more than that in group C （P〈0.05）. The level of NK cells in both groups significantly increased at T1 than that at To, and group D increased more than that in group C （P〈0. 05）. In group C, compared with To and group D the level of IL-2 increased at T1 and T2, while the expression of IL-10 decreased at T
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第11期1051-1054,共4页
Journal of Clinical Anesthesiology
关键词
右美托咪定
结核
手术
免疫
Dexmedetomidine
Tuberculosis
Surgery
Immune
