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目的:评价夜间静脉输注右美托咪定对腹腔镜胃肠肿瘤根治术老年患者术后早期免疫功能的影响。方法:选择择期行腹腔镜胃肠肿瘤根治术患者96例，ASA分级Ⅱ或Ⅲ级，年龄65～78岁，BMI 18～27 kg/mn 2，术前匹兹堡睡眠指数≤16分和简易认知状态评价量表评分≥27分。采用随机数字表法将患者分为3组(n n＝32)：对照组(C组)、右美托咪定0.2 μg·kgn -1·hn -1组(D1组)和右美托咪定0.3 μg·kgn -1·hn -1(D2组)。采用静吸复合麻醉。术毕采用地佐辛和酮咯酸氨丁三醇行PCIA，背景剂量2 ml/h，PCA剂量2 ml，锁定时间30 min，维持VAS评分≤4分。VAS评分>4分时肌肉注射曲马多100 mg补救镇痛。D1组和D2组分别于术日晚9：00和术后第1天晚9：00开始静脉输注右美托咪定0.2和0.3 μg·kgn -1·hn -1至次日晨6：00；C组于相应时段静脉输注生理盐水3 ml/h。分别于术后第1天晨8点和第2天晨8点，采用利兹睡眠评价量表(LSEQ)评价睡眠质量，采用久乐手环监测睡眠时间。分别于术日晨8点和术后第2天晨8点时空腹采集2 ml外周静脉血标本，检测T淋巴细胞百分比、CD4n ＋和CD8n ＋细胞百分比、NK细胞百分比，计算CD4n ＋/CD8n ＋比值。记录术后24 h内和24～48 h的补救镇痛情况。n 结果:与C组比较，D1组和D2组T淋巴细胞百分比、CD4n ＋/CD8n ＋比值和NK细胞百分比升高，睡眠时间延长(n P0.05)。3组间LSEQ评分和补救镇痛率比较差异无统计学意义(n P>0.05)。n 结论:夜间静脉输注右美托咪定可改善腹腔镜胃肠肿瘤根治术老年患者术后早期免疫功能，可能与改善术后睡眠质量有关。“,”Objective:To evaluate the effect of nocturnal intravenous infusion of dexmedetomidine on early postoperative immune function in elderly patients undergoing laparoscopic radical resection of gastrointestinal tumors.Methods:Ninety-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-78 yr, with body mass index of 18-27 kg/mn 2, of Pittsburgh Sleep Quality Index ≤ 16 points and Mini-mental State Examination ≥ 27 points before operation, scheduled for elective laparoscopic radical resection of gastrointestinal tumors, were divided into 3 groups (n n=32 each) using a random number table method: control group (group C), dexmedetomidine 0.2 μg·kg n -1·hn -1 group (group D1) and dexmedetomidine 0.3 μg·kg n -1·hn -1 group (group D2). Combined intravenous-inhalational anesthesia was used.Patient-controlled intravenous analgesia was performed with dezocine and ketorolac tromethamine at the end of operation, with the background dose 2 ml/h, bolus dose 2 ml, and lockout interval 30 min.VAS score was maintained ≤ 4 points, and tramadol 100 mg was intramuscularly injected as rescue analgesic when the VAS score was more than 4 points.Dexmedetomidine 0.2 and 0.3 μg·kg n -1·hn -1 were intravenously infused from 9: 00 p. m.on the day of surgery and the first day after surgery, respectively, until 6: 00 a. m.on the next day.Normal saline 3 ml/h was given instead of dexmedetomidine during the corresponding period in group C. Sleep quality was evaluated by Leeds Sleep Evaluation Scale, and sleep time was monitored by Jiule bracelet at 8: 00 a. m.on the first day (Tn 2) and the second day after surgery (Tn 3). Peripheral venous blood samples were collected on an empty stomach at 8 a. m.on the operation day and at 8 a. m.on the second day after operation for determination of the percentage of T lymphocytes, percentage of CD4n + and CD8n + cells, and percentage of NK cells, and the CD4n + /CD8n + ratio was calculated.The rescue analgesia was recorded within 24 h after operation and in 24-48 h period after operation.n Results:Compared with group C, the percentage of T lymphocytes, CD4n + /CD8n + ratio, and NK cells were significantly increased, and the sleep time was prolonged in D1 and D2 groups (n P0.05). There was no significant difference in the Leeds Sleep Evaluation Scak score and rate of rescue analgesia among the three groups (n P>0.05).n Conclusion:Nocturnal intravenous infusion of dexmedetomidine can improve the early immune function after laparoscopic radical resection of gastrointestinal tumors in elderly patients, which may be related to improving postoperative sleep quality.