| 唐月月,袁从虎,李向南,纪月珑,詹丹丹,陈凤珍.不同剂量右美托咪定混合罗哌卡因超声引导下TPVB联合全身麻醉对胸腔镜下肺癌根治术患者应激反应、免疫功能和微转移的影响[J].,2024,(9):1767-1772 |
| 不同剂量右美托咪定混合罗哌卡因超声引导下TPVB联合全身麻醉对胸腔镜下肺癌根治术患者应激反应、免疫功能和微转移的影响 |
| Effects of Different Doses of Dexmedetomidine Mix with Ropivacaine Ultrasound-Guided TPVB Combine with General Anesthesia on Stress Response, Immune Function and Micrometastasis in Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer |
| 投稿时间：2023-11-12 修订日期：2023-12-07 |
| DOI：10.13241/j.cnki.pmb.2024.09.033 |
| 中文关键词: 胸腔镜下肺癌根治术 右美托咪定 超声引导下胸椎旁神经阻滞 罗哌卡因 免疫功能 应激反应 微转移 |
| 英文关键词: Thoracoscopic radical resection of lung cancer Dexmetomidine Ultrasound-guided thoracic paravertebral nerve block Ropivacaine Immune function Stress response Micrometastasis |
| 基金项目:江苏省高层次卫生人才"六个一工程"拔尖人才科研项目（LGY2017045） |
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| 中文摘要: |
| 摘要 目的：探讨0.5 μg/kg、1.0 μg/kg、1.5 μg/kg三种剂量的右美托咪定混合罗哌卡因超声引导下胸椎旁神经阻滞（TPVB）联合全身麻醉对胸腔镜下肺癌根治术患者应激反应、免疫功能和微转移的影响。方法：选取我院132例行胸腔镜下肺癌根治术的患者，根据随机数字表法将132例患者随机分为高剂量组（1.5 μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB，44例）、中剂量组（1.0 μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB，44例）和低剂量组（0.5 μg/kg的右美托咪定混合罗哌卡因超声引导下TPVB，44例）。对比三组苏醒质量、血流动力学[心率（HR）、收缩压（SBP）、舒张压（DBP）]、应激反应指标[肾上腺素（E）、去甲肾上腺素（NE）、皮质醇（Cor）]、免疫功能[CD3+、CD4+、CD8+，计算CD4+/CD8+]、微转移[表皮生长因子受体信使核糖核酸（EGFR mRNA）、肺特异性X蛋白（LUNX mRNA）、细胞角蛋白19 （CK19 mRNA）]、不良反应发生率。结果：低剂量组、中剂量组、高剂量组的苏醒时间、气管拔管时间、恢复室停留时间依次延长（P<0.05）。低剂量组、中剂量组、高剂量组气管拔管时（T2）、气管拔管5 min时（T3）时间点HR、SBP、DBP依次升高（P<0.05）。低剂量组、中剂量组、高剂量组术后48 h E、NE、Cor依次升高（P<0.05）。低剂量组、中剂量组、高剂量组术后48 h CD8+依次升高，CD3+、CD4+、CD4+/CD8+依次下降（P<0.05）三组术后48 h EGFR mRNA、LUNX mRNA、CK19 mRNA下降，但各组间无显著性差异。三组不良反应发生率组间对比未见差异（P>0.05）。结论：右美托咪定联合罗哌卡因超声引导下TPVB可有效控制胸腔镜下肺癌根治术患者应激反应，维持血流动力学稳定，减轻免疫抑制，改善微转移，以0.5 μg/kg的剂量效果最佳。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of 0.5 μg/kg, 1.0 μg/kg, 1.5 μg/kg three doses of dexmedetomidine mix with ropivacaine ultrasound-guided thoracic paravertebral nerve block(TPVB) combine with general anesthesia on stress response, immune function and micrometastasis in patients undergoing thoracoscopic radical resection of lung cancer. Methods: 132 patients undergoing thoracoscopic radical resection of lung cancer in our hospital were selected, and patients were divided into high dose group (1.5 μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB, 44 cases), middle dose group (1.0 μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB, 44 cases) and low dose group (0.5 μg/kg dexmedetomidine combine with ropivacaine ultrasound-guided TPVB, 44 cases) according to the random number table. The recovery quality, hemodynamics [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], stress response indexes [epinephrine (E), norepinephrine (NE), cortisol (Cor)], immune function [CD3+, CD4+, CD8+, CD4+/CD8+], micrometastasis [epidermal growth factor receptor messenger ribonucleic acid (EGFR mRNA), lung specific X protein (LUNX mRNA), cytokeratin 19 (CK19 mRNA)] and incidence of adverse reactions were compared in three groups. Results: The recovery time, tracheal extubation time and recovery room stay time in low dose group, middle dose group and high dose group were prolonged in turn(P<0.05). HR, SBP and DBP in low dose group, middle dose group and high dose group increased in turn at the time of tracheal extubation (T2) and 5 min after tracheal extubation (T3) (P<0.05). The levels of E, NE and Cor in low dose group, middle dose group and high dose group increased in turn at 48h after operation (P<0.05). CD8+ in low dose group, middle dose group and high dose group increased in turn, while CD3+, CD4+ and CD4+/CD8+ decreased in turn at 48 h after operation (P<0.05). EGFR mRNA, LUNX mRNA, and CK19 mRNA decreased at 48 h after surgery in the three groups, but there was no significant difference between the three groups.There was no difference in the incidence of adverse reactions in three groups(P>0.05). Conclusion: Dexmedetomidine combine with ropivacaine ultrasound-guided TPVB can effectively control the stress response of patients undergoing thoracoscopic radical resection of lung cancer, maintain hemodynamic fluctuations, reduce immunosuppression, and improve micrometastasis, the dose of 0.5 μg/kg is the best. |
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