右美托咪定在老年肺癌合并COPD患者中的麻醉效果及对应激反应和Th1、Th2型细胞因子的影响

摘要 目的：观察右美托咪定在老年肺癌合并慢性阻塞性肺部疾病（COPD）患者中的麻醉效果及对应激反应和辅助T（Th）1、Th2型细胞因子的影响。方法：使用随机数字表法将2019年5月至2022年5月期间在我院行肺叶切除术的100例老年肺癌合并COPD患者分为对照组和治疗组，各为50例。对照组接受常规麻醉，治疗组在对照组基础上接受右美托咪定。对比两组肺动态顺应性、氧合指数、应激反应指标、Th1、Th2型细胞因子，同时记录两组术后并发症发生率。结果：治疗组单肺通气30 min（T2）~术毕（T4）时间点肺动态顺应性、氧合指数高于对照组（P<0.05）。治疗组术后1d皮质醇（Cor）、促肾上腺皮质激素（ACTH）、去甲肾上腺素（NE）、肾上腺素（E）低于对照组（P<0.05）。治疗组术后1 d白细胞介素-2（IL-2）、干扰素-γ ( IFN-γ)、肿瘤坏死因子-α（TNF-α）低于对照组（P<0.05），IL-4、IL-10高于对照组（P<0.05）。两组术后并发症发生率组间对比未见差异（P>0.05）。结论：右美托咪定对老年肺癌合并COPD患者具有较好的麻醉效果，可改善肺部顺应性，保持氧合指数稳定，减轻机体的应激反应，有效调节Th1、Th2型细胞因子。

Anesthetic Effect of Dexmedetomidine in Elderly Patients with Lung Cancer Combined with COPD and its Effect on Stress Response and Th1 and Th2 Cytokines

ABSTRACT Objective: To observe the anesthetic effect of dexmedetomidine in elderly patients with lung cancer combined with chronic obstructive pulmonary disease (COPD) and its effect on stress response and auxiliary T (Th) 1 and Th2 cytokines. Methods: 100 elderly patients with lung cancer combine with COPD who underwent lobectomy in our hospital from May 2019 to May 2022 were divided into control group and treatment group by random number table method, with 50 cases in each group. Control group received routine anesthesia, and treatment group received dexmedetomidine on the basis in control group. The pulmonary dynamic compliance, oxygenation index, stress response index, Th1 and Th2 cytokines were compared in two groups, and the incidence of complications in two groups was recorded after operation. Results: The pulmonary dynamic compliance and oxygenation index in treatment group were higher than those in control group at 30 min (T2) to the end of operation (T4) (P<0.05). The levels of cortisol (Cor), adrenocorticotropic hormone (ACTH), norepinephrine (NE) and epinephrine (E) in treatment group were lower than those in control group 1 day after operation (P<0.05). The levels of interleukin-2 (IL-2), interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) in treatment group were lower than those in control group 1 day after operation (P<0.05), and the levels of IL-4 and IL-10 were higher than those in control group (P<0.05). There was no difference in the incidence of complications in two groups after operation (P>0.05). Conclusion: Dexmedetomidine has a good anesthetic effect on elderly patients with lung cancer combined with COPD, which can improve lung compliance, maintain stable oxygenation index, reduce the body''s stress response, and effectively regulate Th1 and Th2 cytokines.