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

doi:10.3969/j.issn.1002-7386.2018.09.020

Abstract：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.