【摘要】 目的:观察右美托咪定（DEX）联合硬膜外阻滞对食管癌患者术后免疫功能及恢复质量的影响。方法:选择择期行食管癌中段手术患者120例,美国麻醉协会（ASA）分级Ⅰ～Ⅱ级,按照随机数字表法分为DEX联合硬膜外阻滞复合全麻组（D组）、硬膜外阻滞复合全麻组（E组）、全麻组（G组）,每组40例。D组患者入室后经T_6～7间隙行硬膜外穿刺置管,切皮前注入0.4%盐酸罗哌卡因10 mL,之后每1 h注入0.4%盐酸罗哌卡因5 mL,麻醉诱导前缓慢泵注DEX 1μg/kg,术中以0.05μg·kg^-1□h^-1的速度持续泵注至手术结束前30 min; E组硬膜外置管操作同D组,全麻方法同G组;G组单纯全麻。三组的麻醉诱导维持方案相同。术后D组和E组采用硬膜外镇痛,G组采用静脉镇痛。于麻醉前（t₀）、手术结束时（t₁）、术后24 h（t₂）、术后48 h（t₃）采集静脉血检测CD3⁺,CD4⁺,CD8⁺水平,并记录患者苏醒时间、术后2 h Ramay镇静评分、术后24 h和48 h疼痛视觉模拟评分（VAS评分）及胃肠道恢复情况。结果:在t₁-t₃时间点D组和E组CD3⁺和CD4⁺水平明显高于G组,且D组高于E组,差异有统计学意义（P<0.05）;D组患者的苏醒时间明显低于E组和G组（P<0.05）;术后2 h Ramay镇静评分D组明显高于E组和G组（P<0.05）;术后24 h和48 h VAS评分D组和E组明显低于G组（P<0.05）;术后D组和E组的排气时间、排便时间及患者进食时间均明显短于G组（P<0.05）。结论:右美托咪定联合硬膜外阻滞应用于食管癌手术患者,可以改善患者术后的免疫功能,缩短患者的苏醒时间,降低镇静评分,同时减轻患者术后疼痛,加速促进胃肠道功能的恢复。更多还原

【Abstract】 Objective: To observe the effect of dexmedetomidine（DEX） combined with epidural block on immune function and postoperative recovery quality in patients with esophageal cancer.Methods: Selecting 120 patients with elective middle segment of esophageal carcinoma, ASA grade Ⅰ～Ⅱ,divided into 3 groups according to random number, dexmetomidine combined with epidural block combined with general anesthesia group（D group）,epidural block combined with general anesthesia group（E group）,simple general anesthesia group（G group）,each group 40 cases.After entering the room, patients in group D received epidural puncture and catheterization between 6 th and 7 th thoracic vertebra, 10 mL 0.4% ropivacaine was injected into the space, and 5 mL 0.4% ropivacaine was added to the catheter every hour, 1 μg/kg of dexmedetomidine was pumped slowly before induction of anesthesia, pump continuously at 0.05 μg·kg^-1□b·h^-1 until 30 min before operation.The operation of the epidural tube in group E is the same as that in group D.General anesthesia alone in G group.Three groups had the same anesthesia induction maintenance protocol.After operation, postoperative epidural analgesia was used in group D and E,and intravenous analgesia was used in group G.The venous blood was collected before anesthesia（t₀）,at the end of operation（t₁）,24 hours after operation（t₂）,and 48 hours after operation（t₃）,and the levels of CD3⁺,CD4⁺,CD8⁺ were detected.The recovery time of patients, Ramsay sedation score 2 hours after surgery, 24 h visual analogue scale（VAS） and 48 hVAS score and gastrointestinal recovery were recorded.Results: From t₁ to t₃,the levels of CD3⁺ and CD4⁺ in group D and group E were significantly higher than of the G group（P<0.05）,the levels of CD3⁺ and CD4⁺ in group were significantly higher from t₁ to t₃（P<0.05）.The recovery time of patients in D group was significantly shorter than that in E group and G group（P<0.05）.The scores of 2 h Ramay sedation in D group were significantly higher than those in E groupand G group（P<0.05）,the scores of 24 h and 48 hVAS after operation was significantly lower in D group and E group than in G group（P<0.05）.The exhaust time, defecation time and eating time of patients in group D and E after operation were significantly lower than those in group G（P<0.05）.Conclusion: Patients with esophageal cancer use dexmedetomidine combined with epidural block improve postoperative immune function, Improve the recovery quality and sedation score of patients, relieve postoperative pain and accelerate the recovery of gastrointestinal function.更多还原