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目的观察右美托咪定复合复方利多卡因乳膏对腭咽成形术带管期间应激及细胞免疫功能的影响。方法择期经鼻气管插管腭咽成形术患者,随机分为复方利多卡因乳膏+右美托咪定组(观察组)和石蜡油+咪达唑仑组(对照组),每组30例。观察组以复方利多卡因乳膏涂布气管导管前2/3,入ICU后以右美托咪定维持微量泵泵注;对照组以石蜡油涂布气管导管前2/3,入ICU后以咪达唑仑维持泵注。于诱导前5 min(T0)、拔管后5 min(T1)、术后1 d(T2)及术后3 d(T3)抽血标本测定血糖及血浆皮质醇浓度、T淋巴亚群CD_3~+、CD_4~+、CD_8~+和NK细胞水平,计算CD_4~+/CD_8~+值。结果细胞免疫指标与T0比较,2组患者CD_3~+、CD_4~+、CD_4~+/CD_8~+在T1、T2下降,观察组CD_3~+、CD_4~+在T1~T3,CD_4~+/CD_8~+在T1高于对照组,差异有统计学意义(P<0.05);2组NK细胞在T1、T2升高,观察组在T1、T2低于对照组,差异有统计学意义(P<0.05)。应激指标与T0比较,2组血糖、皮质醇在T1、T2升高,观察组血糖在T1~T3,皮质醇在T1、T3均低于对照组,差异有统计学意义(P<0.05)。结论右美托咪定与复方利多卡因乳膏联合应用于UPPP患者术后ICU带管期间镇静、镇痛,可减轻围术期应激反应,改善细胞免疫抑制。
Objective To observe the effect of dexmedetomidine and compound lidocaine cream on stress and cellular immune function during velopharyngeal angioplasty. Methods Elective nasopharyngeal intratracheal otomy was randomly divided into compound lidocaine cream + dexmedetomidine group (observation group) and paraffin oil + midazolam group (control group), each group 30 example. The observation group was treated with compound lidocaine cream before 2/3 of the tracheal tube, and then the dexmedetomidine was injected into the ICU to maintain the micropump pump. In the control group, paraffin oil was used to coat the tracheal tube 2/3 before intubation into the ICU To midazolam maintenance pump. Blood glucose and plasma cortisol levels were measured at 5 min before induction (T0), 5 min after extubation (T1), 1 d after operation (T2) and 3 d after operation (T3) +, CD_4 ~ +, CD_8 ~ + and NK cell levels, calculated CD_4 ~ + / CD_8 ~ + value. Results Compared with T0, the levels of CD_3 ~ +, CD_4 ~ +, CD_4 ~ + / CD_8 ~ + in the two groups were decreased at T1 and T2. The CD_3 ~ + and CD_4 ~ CD_8 ~ + in T1 was higher than that in control group, the difference was statistically significant (P <0.05); NK cells in two groups were increased at T1 and T2, the observation group was lower at T1 and T2 than the control group, the difference was statistically significant (P <0.05). Compared with T0, the level of blood glucose and cortisol in both groups increased at T1 and T2. The blood glucose in the observation group was lower at T1 ~ T3 and cortisol at T1 and T3, the difference was statistically significant (P0.05) . Conclusion Combination of dexmedetomidine and compound lidocaine cream for sedation and analgesia during postoperative ICU with UPPP can reduce perioperative stress response and improve cellular immunosuppression.