右美托咪定对胃癌根治术患者围术期白细胞介素-6、皮质醇及T淋巴细胞亚群的影响

目的观察右美托咪定对胃癌根治术患者围术期白细胞介素-6(IL-6)、皮质醇(Cor)及T淋巴细胞亚群的影响。方法 40例择期全麻下行胃癌根治术患者,随机均分为右美托咪定组(D组)和对照组(C组)。两组分别于麻醉诱导时在15min内静脉泵入1μg/kg右美托咪定和等容量的生理盐水,随后持续静脉输注右美托咪定0.2～0.7μg·kg-1·h-1和生理盐水0.125ml·kg-1·h-1。检测麻醉诱导前(T0)、切皮前(T1)、手术1h(T2)、术毕(T3)、术后1d(T4)和术后3d(T5)血清IL-6、血浆Cor浓度及外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平。结果与T0时比较,C组T2～T4时血清IL-6和T2、T3时血浆Cor浓度升高(P<0.05);T1～T5时CD3+、CD4+、CD8+、CD4+/CD8+显著下降(P<0.05);D组血清IL-6及血浆Cor浓度无明显变化,T2和T3时CD3+、CD4+、CD8+、CD4+/CD8+显著上升(P<0.05)。结论全麻期间持续静脉输注右美托咪定可有效抑制胃癌根治术患者围术期的应激反应,减少细胞免疫功能的抑制。

Effects of dexmedetomidine on IL-6, cortisol and T-lymphocyte subsets in patients undergoing radical gastric cancer surgery

Objective To observe the effects of dexmedetomidine on IL-6, cortisol and T-lymphocyte subsets in patients undergoing radical gastric cancer surgery.Methods Forty patients with gastric cancer undergoing radical gastrectomy were equally randomized to dexmedetomidine group (group D) and control group (group C). Patients in group D were given a loading dose of dexmedetomidine 1 μg/kg within 15 minutes followed by a continuous infusion of 0.2-0.7 μg·kg-1·h-1, whereas patients in group C received the same volume of normal saline. The levels of serum IL-6, plasma cortisol and peripheral blood T-lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+) were detected before the induction of anesthesia (T0), before incision (T1), 1 h after the beginning of the operation (T2), at the end of the operation (T3), 1 day after operation (T4) and 3 days after operation (T5).Results Compared with T0, serum IL-6 at T2-T4 and plasma cortisol at T2, T3 increased (P<0.05), while CD3+, CD4+, CD8+ and CD4+/CD8+ at T1-T5 decreased in group C (P<0.05). There was no significant change in serum IL-6 or plasma cortisol in group D, while CD3+, CD4+, CD8+ and CD4+/CD8+ at T2 and T3 increased in group D (P<0.05).Conclusion A continuous intravenous infusion of dexmedetomidine may effectively inhibit the stress responses and reduce the inhibition of cellular immune function in patients undergoing radical gastrectomy.