| 蔡 哲,索良源,王 怡,张维清,黄泽清.右美托咪定对老年恶性肿瘤全麻手术患者术后细胞免疫功能、认知功能及炎症因子水平的影响[J].,2019,19(24):4655-4659 |
| 右美托咪定对老年恶性肿瘤全麻手术患者术后细胞免疫功能、认知功能及炎症因子水平的影响 |
| The Effect of Dexmedetomidine on the Cellular Immune Function, Cognitive Function and Inflammatory Factors in the Elderly Patients Undergoing General Anesthesia |
| 投稿时间：2019-08-27 修订日期：2019-09-23 |
| DOI：10.13241/j.cnki.pmb.2019.24.012 |
| 中文关键词: 右美托咪定 老年 恶性肿瘤 全麻 细胞免疫 认知功能 炎症因子 |
| 英文关键词: Dexmedetomidine Elderly Malignant tumor General anesthesia Immune function Cognitive function Inflammatory factors |
| 基金项目:辽宁省科学技术计划项目（2015228011） |
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| 摘要 目的：探讨右美托咪定对老年恶性肿瘤全麻手术患者术后细胞免疫功能、认知功能及炎症因子水平的影响。方法：选取2017年2月~2019年6月期间到我院择期行手术治疗的老年恶性肿瘤患者119例，根据随机数字表法将患者分为对照组（n=59）和研究组（n=60），研究组麻醉中输注右美托咪定，对照组麻醉中输注同容量等速率的生理盐水，比较两组患者围术期指标、细胞免疫功能、不良反应、炎症因子指标、简易智力状态量表（MMSE）评分。结果：两组患者术后第3 d的 CD4+/CD8+、CD3+、CD4+较术前下降，CD8+较术前升高（P<0.05）；研究组术后第3 d 的CD4+/CD8+、CD3+、CD4+高于对照组，CD8+则低于对照组（P<0.05）。两组术后第3 d的血清高迁移率族蛋白 1（HMGBl）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平均升高，但研究组低于对照组（P<0.05）。两组手术时间、术中出血量、麻醉时间比较无差异（P>0.05）。两组患者术前、术后第1 d、术后第3 d的MMSE评分呈先下降后升高趋势（P<0.05），且研究组术后第1 d、第3 d的MMSE评分高于对照组（P<0.05）。两组不良反应发生率比较无统计学差异（P>0.05）。结论：老年恶性肿瘤全麻手术患者术中输注右美托咪定，可减轻细胞免疫抑制及炎症反应，对术后早期的认知功能下降有一定预防作用。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of dexmedetomidine on the cellular immune function, cognitive function and inflammatory factors in the elderly patients undergoing general anesthesia. Methods: A total of 119 patients with malignant tumors in our hospital from February 2017 to June 2019 were selected for operation treatment. According to the method of random number table, the patients were divided into control group (n=59) and study group (n=60). In the study group, dexmedetomidine was infused during anesthesia, while in the control group, normal saline with the same volume and the same rate was infused during anesthesia. The perioperative indexes, cellular immune function and Mini-mental State Examination (MMSE) score and inflammatory factors of the two groups were compared, and adverse reactions of the two groups during the treatment were recorded. Results: The CD4+/CD8+, CD3+, CD4+ of the patients in the two groups on the 3d after operation were decreased, and the CD8+ increased compared with the preoperative(P<0.05). The CD4+/CD8+, CD3+, CD4+ in the study group on the 3d after operation were higher than those in the control group, and CD8+ was lower than that in the control group (P<0.05). The levels of high mobility group protein 1 (HMGBl), interleukin-6 (IL-6) and tumor necrosis factor - α (TNF-α) in the serum of the two groups on the 3d after operation were all increased, but those in the study group were lower than those in the control group (P<0.05). There were no significant differences in intraoperative hemorrhage volume, operation time and anesthesia time between the two groups (P>0.05). The MMSE score of the 1 d and 3 d after operation in the two groups decreased first and then increased (P<0.05). The MMSE score of the 1 d and 3 d after operation in the study group were higher than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: The infusion of dexmedetomidine during the operation of general anesthesia for the elderly cancer patients can reduce the cellular immunosuppression and inflammatory response, which has a certain preventive effect on the early postoperative cognitive decline. |
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