南京市溧水区人民医院(东南大学附属中大医院溧水分院) 麻醉科，江苏 南京 211200
Department of Anesthesiology, Lishui People’s Hospital (Zhongda Hospital Lishui Branch, Southeast University), Nanjing, Jiangsu 211200, China
目的 探讨右美托咪定联合综合体温保护对腔镜手术治疗老年恶性肿瘤患者苏醒期质量及免疫功能的影响。方法 选择择期行腔镜手术治疗的老年恶性肿瘤患者90例，随机均分为3组：对照组（C组）、体温保护组（T组）和体温保护联合右美托咪定组（T-D组），每组30例。C组常规体温保护，T组和T-D组综合体温保护；T-D组麻醉诱导前10 min泵注右美托咪定0.5 μg/kg。记录3组患者麻醉诱导开始时（T0）、手术开始30 min（T1）、60 min（T2）、90 min（T3）、120 min（T4）以及手术结束时（T5）的鼻咽温度；于T0、术后2 h（T6）、24 h（T7）和48 h（T8）时抽取静脉血标本，测定T淋巴细胞亚群（CD3+、CD4+和CD8+）和自然杀伤细胞（NK cell）水平；记录患者术中麻醉药物用量及苏醒期质量指标。结果 与T0比较，C组T2～T5时点鼻咽温度均明显降低（P < 0.05）；与C组比较，T组和T-D组T2～T5时点鼻咽温度明显升高（P < 0.05）。与T0时点比较，C组、T组和T-D组T6、T7和T8时点CD3+和NK cell活性均明显降低（P < 0.05）；C组在T6、T7和T8时点，T组和T-D组在T6和T7时点，CD4+活性均明显降低（P < 0.05）。与C组比较，T组和T-D组T6和T7时点CD3+细胞活性均明显升高（P < 0.05）；T组在T7时点，T-D组在T6和T7时点，CD4+细胞活性均明显升高（P < 0.05）；T组在T7时点，T-D组在T6、T7和T8时点，NK cell活性均明显升高（P < 0.05）。结论 采用体温保护措施联合右美托咪定能够维持老年恶性肿瘤患者的体温稳定，减少围手术期意外低体温（IPH）的发生，并有效提高患者苏醒期质量，减轻免疫抑制程度，加速患者早期恢复。
Objective To observe Dexmedetomidine combined with comprehensive temperature protection on the quality and immune function of elderly patients underwent endoscopic surgery for malignant tumor during recovery temperature protection on the quality of recovery.Methods 90 elderly patients underwent laparoscopic malignant tumor surgery were randomly divided into three groups: control group (group C), temperature protection group (group T) and temperature protection combined with Dexmedetomidine group (group T-D), 30 cases in each. Thermal insulation in routine operation were adopted in group C, while in group T and group T-D comprehensive temperature protection measures were employed. In groupT-D, Dexmedetomidine were given intravenously at 0.5 μg/kg 10 min before anesthesia induction. The nasopharyngeal temperature was recorded at the beginning of anesthesia (T0), 30 min (T1), 60 min (T2), 90 min (T3) and 120 min surgery (T4), at the end of surgery (T5). Venous blood samples were extracted at T0, 2 h after operation (T6), 24 h after operation (T7), 48 h after operation (T8) for detection of T lymphocyte subsets (CD3+, CD4+, CD8+) and natural killer (NK) cells levels. Intraoperative amount of anesthetic drugs and quality indicators of recovery period were recorded.Results Compared with T0, the nasopharyngeal temperature in group C at T2 ~ T5 time points was significantly decreased (P < 0.05), the nasopharyngeal temperature in group T and group T-D at T2 ~ T5 time points was obviously higher than those of in group C (P < 0.05). Compared with T0, the levels of CD3+ and NK cells in group C, group T and group T-D were significantly decreased at T6、T7、T8 (P < 0.05). The levels of CD4+ at T6、T7、T8 in group C, at T6, T7 in group T and group T-D were significantly decreased (P < 0.05). Compared with group C, the levels of CD3+ at T6, T7 in group T and group T-D were obviously increased (P < 0.05). The levels of CD4+ at T7 in group T, at T6, T7 in group T-D were obviously higher than those in group C (P < 0.05). The levels of NK cells, at T7 in group T, at T6、T7 and T8 in group T-D were obviously higher than those in group C (P < 0.05).Conclusion Body temperature protection combined with Dexmedetomidine can maintain a stable body temperature, reduce the occurrence of inadvertent perioperative hypothermia (IPH), effectively improve the quality of recovery period and alleviate the inhibitory degree of the cellular immune function in elderly patients underwent laparoscopic malignant tumor surgery, thus, it can further promote earlier recovery.