目的:探讨0。5μg/kg、1。0μg/kg、1。5μg/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。5μg/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(EGFRmR-NA)、肺特异性X蛋白(LUNXmRNA)、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 mR-NA、CK19mRNA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。5μg/kg的剂量效果最佳。
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
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 com-bine with ropivacaine ultrasound-guided TPVB,44 cases)and low dose group(0.5 pg/kg dexmedetomidine combine with ropivacaine ul-trasound-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)],im-mune 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 tum(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:Dexmedeto-midine combine with ropivacaine ultrasound-guided TPVB can effectively control the stress response of patients undergoing thoraco-scopic 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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