Effect Of Nalbuphine Combined With Dexmetomidine On Immune Response In Patients Undergoing Glioma Surgery

Objective:The changes of CD3+,CD3+CD8+,CD3+CD4+,CD16+CD56+(NK cells),IL-6 and IL-10 were observed to explore the effect of nalbuphine hydrochloride combined with dexmedetomidine on immune inflammatory response in patients with glioma.Methods:120 patients under general anesthesia who underwent elective craniotomy for glioma,aged 20-60,ASA grade Ⅰ-Ⅱ,exclusion of patients taking immunosuppressive drugs and other sedative analgesic drugs,were randomly divided into four groups(n=30):group D+N(nalbuphine combined with dexmedetomidine group:Dex 0.Sug/kg·min-1 was pumped 30 minutes before induction for 10 minutes.Then 0.5ug/kg·h-1 was pumped continuously before suturing the dura mater,and then intravenous injection of nalbuphine hydrochloride 0.2mg/kg was performed 5 minutes before the incision),group D(dexmedetomidine group:Dex 0.5ug/kg·min-1 was pumped was 30 minutes before induction for 10 minutes and then 0.5ug/kg·h-1 was pumped continuously before suturing the dura mater.No nalbuphine was given),group N(nalbuphine hydrochloride group,incision:nalbuphine hydrochloride 0.2 mg/kg was injected intravenously 5 minutes before skin incision,but Dex was not given.),group C(control group:equal volume of saline pump and intravenous injection),the remaining anesthesia regimens were the same in each group.Routine monitoring of ECG,HR,invasive arterial blood pressure(SBP,DBP,MAP),SPO2,PETC02,BIS,local anesthesia for arterial puncture catheterization,anesthesia-induced intubation followed by right internal jugular vein catheterization.Respectively,before the induction of anesthesia(TO),incision(T2),intracranial tumor resection(T3),6 hours of incision(T5),24 hours after surgery(T6),patients were collected for venous blood to detect inflammatory related factor IL-6.IL-10,and counting of immune cells CD3+,CD3+CD8+,CD3+CD4+,NK cells.Results:1.There was no significant difference in HR and MAP between the four groups at TO(P>0.05).At T1,T2 and T4,the order of the levels of HR and MAP from low to high of the four groups was D+N group,D group,N group and C group(P<0.05),among which the levels of HR and MAP at T1,T2 and T4 in D+N group and D group were lower than those in the same group(P<0 05),and the levels of HR and MAP at T1,T2 and T4 in group N and group C were significantly higher than those in the same group TO(P<0 05).2.Comparison of postoperative pain visual analogue scale(VAS score)and RASS sedation scoreThe VAS scores in the D+N group were lower than those in the D,N,and C groups at1 hour after the operation(P<0.05),but there was no significant difference in the VAS scores of Group D,N,and C at 1 hour after the operation(P>0.05).There were no significant differences in VAS scores between the four groups at 6 hours and 24 hours after the operation(P>0.05).The RASS score in D group was lower than those in D,N and C groups at 1 hour afterthe operation,but there was no significant difference in RASS scores of D,N and C groups at 1 hour after the operation(P>0 05).There was no significant difference in RASS scores of the four groups at 6 hours and 24 hours after the operation(P>0.05).3.Changes of inflammatory factors in blood of patients There were no significant differences in IL-6 and IL-10 between the four groups at TO(P>0.05),but IL-6 and IL-10 increased gradually at T2,T3 and T5(P<0.05).The level of T6 in D+N group and D group was lower than those at T5(P<0.05),but higher than those at TO(P<0.05).IL-6 and IL-10 were higher in T group than in group C and T group(P<0.05).At T2,T3,T5 and T6,IL-6 and IL-10 were from low to high in D group,N group and C group(P<0 05).4.Changes in the number of immune cells in patients The CD3+,CD3+CD8+,CD3+CD4+and NK cells counts in the four groups decreased gradually at T2 and T3(P<0.05),and increased in D+N and D groups at T5,and higher than T2(P<0.05).The CD3+,CD3+CD8+,CD3+CD4+,and NK cell counts in the four groups were lower than those in the same group(P<0.05),and accordingly the D+N group,D group,N group,and C group were ranked from high to low(P).<0.05).Conclusion:1.Nalbuphine combined with dexmedetomidine has a good sedative and analgesic effect and effectively stabilizes hemodynamics.2.Nalbuphine combined with dexmedetomidine reduces the expression of inflammatory related factors IL-6 and IL-10 in patients undergoing glioma surgery,and alleviated the inflammatory response.3.Nalbuphine combined with dexmedetomidine affects the immune cells CD3+,CD3+CD8+,CD3+CD4+,NK cell counts in patients undergoing glioma surgery,and the recovery of immune function is accelerated in the early postoperative period.