Objective To observe the effects of different doses of dexmedetomidine combined with remifentanil anesthesia and propofol controlled hypotension on stress response and immune function of patients receiving nose endoscopic operation.Methods One hundred and twenty patients who were ready to be treated by nose endoscopic operation were divide into group A, group B, group C and group D according to random number table,with 30 patients in each group. All the patients underwent surgical treatment under general anesthesia,who were given propofol 2mg/kg by intravenous injection, atracurium 0.6~1.0mg/kg and remifentanil 2μg/kg to induce anesthesia, and mechanical ventilation was performed after trachea cannula,then maintaining anesthesia by continuously pumping infusing propofol 4~8mg·kg-1·h-1and remifentanil 0.25μg·kg-1·min-1and interruptably injecting atracurium. The patients in group B, C and D received intravenous pumping dexmedetomidine 0.5μg/kg, 0.8μg/kg,1.0μg/kg,respectively at 10 minutes before anesthesia induction, then maintaining anesthesia at the dose of 0.5μg·kg-1·h-1until the end of surgery, however,the patients in group A received the same volume of 0.9% sodium chloride solution via a pump at 15 minnutes before anesthesia induction. ELISA was used to detect the serum levels of IL-6,TNF-α and CRP in the four groups before anesthesia induction(T0),24 hours after operation (T1) and 48 hours after operation(T2). T lymphocyte subgroups including CD+3,CD+4,CD+8,and the percentage of CD+4/CD+8were measured by flowcytometry.Results There were no significant differences in the serum levels of IL-6,TNF-α,and CRP at T0 among the four groups (P>0.05),as compared with those at T0, the levels of IL-6, TNF-α, and CRP were significantly increased at T1,T2 in the four groups (P<0.05), moreover,which in group B, C, and D were significantly lower than those in group A(P<0.05),and there were no significant differences between group C and group D(P>0.05). There were no significant differences in the levels of CD+3,CD+4,CD+8and the ratio of CD+4/CD+8at T0 among the four groups (P>0.05).As compared with those at T0,the levels of CD+3,CD+4,CD+8and ratio of CD+4/CD+8were significantly decreased at T1,T2 in the four groups (P<0.05).Besides the levels of CD+3,CD+4,CD+8and the ratio of CD+4/CD+8in group B,C,and D were significantly higher than those in group A (P<0.05),however,there were no significant differences between group C and group D (P >0.05).Conclusion The dexmedetomidine combined with remifentanil anesthesia and propofo controlled hypotension can effectively inhibit inflammatory reaction,improve immune function of patients receiving nose endoscopic operation,moreover,the effects of middle and high doses dexmedetomidine are more significant.%目的 观察不同剂量右美托咪定复合瑞芬太尼-丙泊酚控制性降压对鼻内窥镜手术患者应激反应和免疫功能的影响.方法 选取拟行鼻内窥镜手术患者120例,按随机数字表法分为4组,即A组、B组、C组和D组,每组30例.所有患者均在全身麻醉下行手术,静脉注射丙泊酚2 mg/kg、阿曲库铵0.6~1.0 mg/kg、瑞芬太尼2 μg/kg诱导麻醉,气管插管后行机械通气,继以丙泊酚4~8 mg·kg-1·h-1和瑞芬太尼0.25 μg·kg-1·min-1持续泵注并间断注射阿曲库铵维持麻醉.B组、C组、D组分别于麻醉诱导前10 min静脉泵注0.5 μg/kg、0.8 μg/kg、1.0 μg/kg右美托咪定,并以0.5 μg·kg-1·h-1维持至手术结束;A 组输注等量0.9%氯化钠溶液.采用酶联免疫吸附实验(ELISA)测定麻醉诱导前(T0)、术后24 h(T1)、术后48 h(T2)血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平.流式细胞术测定T0、T1、T2时血清T淋巴细胞亚群(CD+3、CD+4、CD+8、CD+4/CD+8)水平.结果T0时4组IL-6、TNF-α、CRP水平比较差异无统计学意义(P>0.05);与T0时比较,T1、T2时4组IL-6、TNF-α、CRP水平明显升高(P<0.05),且B、C、D组低于A组(P<0.05),C、D组比较差异无统计学意义(P>0.05).T0时4组CD+3、CD+4、CD+8、CD+4/CD+8水平比较差异无统计学意义(P>0.05);与T0时比较,T1、T2时4组CD+3、CD+4、CD+8、CD+4/CD+8水平明显降低(P<0.05),且B、C、D组高于A组(P<0.05),C、D组比较差异无统计学意义(P>0.05).结论 右美托咪定复合瑞芬太尼-丙泊酚控制性降压用于鼻内窥镜手术患者能够有效抑制机体炎性反应,改善免疫功能,其中中高剂量右美托咪定效果最为显著.
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