Effects Of Different Anesthetic Methods On Perioperative Immune Functions In Patients Underwent Radical Resection Of Lung Carcinoma By Video-assisted Thoracic Surgery

Objective This study was designed to investigate the effects of dexmedetomidine and epidural block on perioperative immune functions,inflammatory reactions,sedation,analgesia in patients underwent radical resection of lung carcinoma by video-assisted thoracic surgery?VATS?in order to establish an appropriate anesthetic method.Methods 90 patients,aged from 18 to 75,males or females,who received scheduled radical resection of lung carcinoma by VATS were involved in this study.Patients were divided into three groups randomly.General anaesthesia?Group G,n=30?,General anaesthesia combined with dexmedetomidine?Group GD,n=30?,General anesthesia combined with epidural block?Group GE,n=30?.Patients were induced with propofol,sufentanil,rocuronium and received double-lumen endobronchial intubation.Patients of Group GD received dexmedetomidine 1?g/kg by continuous intravenous pumping at the end of induction.Patients in Group G received the same dose of saline.Patients of Group GE received epidural block before the induction,2%lidocaine 3ml to determine the level of blocking,then 0.375%ropivacaine at the speed of 3⁵ ml/h.The anesthetic drugs were adjusted according to the bispectral index during the whole operation.Blood samples were taken at preoperative time?T₀?,at the end of surgery?T₁?and at 24h after the surgery?T₂?for analysis.The percentage of CD3+,CD4+,CD8+T lymphocytes as well as the natural killer cells?NK?and the levels of immunoglobulin A,G,M?IgA,IgG,IgM?,Interleukin-1?,6,10?IL-1?,IL-6,IL-10?were detected.The infusion of propofol,sufentanil,fluid,whole time of operation and special circumstances during the operation were recorded.Scores of sedation and analgesia at 2h?T₃?and 24h?T₄?after the surgery,adverse reactions,complications and time of hospitalization were also recorded.Results Six patients of Group G,two of Group GD and five of Group GE were exclueded.There's no significant differences of gender,age,height,weight,operation time among the three groups?P>0.05?.When compared with T₀,the percentage of CD3+,CD4+T lymphocytes as well as the NK and the levels of IgA,IgG,IgM were decreased significantly at T₁ and T₂?P<0.05?,Il-1?,IL-6 and IL-10 were increased significantly?P<0.05?.However there's no significant differences of the percentage of CD3+,CD4+,CD8+T lymphocytes as well as the natural killer cells?NK?and the levels of immunoglobulin A,G,M?IgA,IgG,IgM?among the three groups?P>0.05?.When compared with Group G,the levels of IL-1?and IL-6 were decreased significantly,IL-10 was increased significantly.When compared with Group G,the sedation of patients were significantly better in Group GD and Group GE?P<0.05?.The postoperative analgesia was significantly better in Group GE than the other two groups?P<0.05?.Conclusion For patients underwent thoracoscopic lung resection,compared with general anesthesia without dexmedetomidine,general anesthesia combined with dexmedetomidine can reduce the release of inflammatory cytokines and incidence of postoperative nausea,improve the postoperative sedation.However,general anesthesia combined with epidural block had the advantages above all.And the postoperative analgesia in the group of epidural block was the best.So dexmedetomidine can not replace the epidural block completely.And for patients underwent thoracoscopic lung resection,the best method of anesthesia was general anesthesia combined with epidural block.